The Way You Think Affects Your Mental Health, Part 3: Anorexia Nervosa

In The Way You Think Affects Your Mental Health Part 1 and Part 2, I discussed how the way one thinks affects his or her mental health, with specific focus on depression.

This article will introduce another group of mental disorders that can be affected by cognition: feeding and eating disorders.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th Ed., DSM-V), an eating or feeding disorder is a “persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food… significantly impairs physical health or psychosocial functioning“.

More specifically, we’ll be looking at anorexia nervosa (AN), one of the more prevalent eating disorders.

Three criteria that must be present for a clinical diagnosis are:

Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health (“Significantly low weight” is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected)
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Unlike bulimia nervosa, significantly low weight must be present in anorexia nervosa. Although both bulimia nervosa and anorexia nervosa can involve restrictive or binging/purging eating behaviors, many individuals with bulimia nervosa can be at a average (or even above average) body weight, whereas all individuals with anorexia nervosa have an abnormally low body weight.

Two of the three criteria are not physical symptoms, but cognitive and mental ones; the most important part to note here is the disturbance in self-perceived weight or shape. One popular method of treatment for anorexia is Cognitive-Behavioral Therapy (CBT), and a method of combating this maladaptive and inaccurate self-image the patients have of themselves is a type of body mapping.

Patients would:

Draw a life-sized outline of what they deemed to be the “perfect” body shape
Draw a life-sized outline of what they thought their actual body shape was
Lie down so that the therapist could draw the patient’s actual body shape within the outline completed in #2

This exercise is conducted to show patients that their self-schemas (in psychology, enduring and stable set of thoughts that summarize a person’s beliefs, experiences and generalizations about the self; how one thinks about his or her self) is inaccurate.

After thinking a certain way about their bodies for an extended period of time, the visuospatial skills of individuals with AN actually became inaccurate. (Another example of how our minds can play tricks on us…)

…which could lead to exacerbation of the restrictive eating behaviors, creating a nasty cycle of negative thoughts leading to negative behaviors leading to more negative thoughts,… and so on and so forth.

If the way we think affects how we feel (and even how we see), shouldn’t we be more conscious and wary of how we think?

Your thoughts can affect you, and even manifest in various mental disorders. So try to think positively, or you might find yourself developing a way of thinking that will affect more than just your mood.

Think about it.

Behavioral Science. Duequesne University. http://www.duq.edu/academics/schools/leadership-and-professional-advancement/undergraduate-degrees/behavioral-science

Blay, S. L. (2009). Anorexia nervosa treatment from the patient perspective: a metasynthesis of qualitative studies. Annals of Clinical Psychiatry, 21(1), 38-48.

Davies, H., Schmidt, U., Stahl, D., & Tchanturia, K. (2011). Evoked facial emotional expression and emotional experience in people with anorexia nervosa. International Journal of Eating Disorders, 44(6), 531-539.

Catastrophizing. http://psychcentral.com/lib/what-is-catastrophizing/0001276

Hatch, A., Madden, S., Kohn, M. R., Clarke, S., Touyz, S., Gordon, E., & Williams, L. M. (2010). Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment. Journal of psychiatry & neuroscience: JPN, 35(4), 267.

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Marques L, Alegria M, Becker AE, et al: Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders. Int J Eat Disord 44(5):412–420, 2011

Sloan, G. (1999). Anorexia nervosa: A cognitive-behavioural approach. Nursing Standard. 13(19): 43-47.