Cognitive Therapy and Research

, Volume 14, Issue 2, pp 191–214 | Cite as

The investigation of schematic content and processing in eating disorders

  • Kelly Bemis Vitousek
  • Steven D. Hollon
Article

Abstract

The core psychopathology of anorexia nervosa and bulimia nervosa is hypothesized to be represented in organized cognitive structures that unite views of the self with beliefs about weight. These weight-related self-schemata may exert automatic effects on the processing of information, and may also help to account for the clinical observation that patients frequently regard their symptoms as serving a valued function. Strategies for assessing the presence and operation of self-schemata in the eating disorders are outlined, and the limitations of inventories designed to measure self-statements about food and weight are emphasized. It is suggested that the “cognitive essence” of these disorders may be found in potent and inclusive schemata that reduce ambiguity, facilitate judgments and predictions, and provide a simple set of premises from which specific rules can be deduced. Several constructs are recommended for further study, including a preference for simplicity, a preference for certainty, and a distinctive “New Year's resolution” cognitive style.

Key words

eating, disorders anorexia nervosa bulimia nervosa schema cognitive assessment 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bemis, K. M. (1983). A comparison of functional relationships in anorexia nervosa and phobia. In P. L. Darby, P. E. Garfinkel, D. M. Garner, & D. V. Coscina (Eds.),Anorexia nervosa: Recent developments in research. New York: Allan R. Liss, pp. 403–415.Google Scholar
  2. Bemis, K. M. (1986).A comparison of the subjective experience of individuals with eating disorders and phobic disorders. Unpublished doctoral dissertation, University of Minnesota, Minneapolis, MN.Google Scholar
  3. Bemis, K. M. (1987). The present status of operant conditioning for the treatment of anorexia nervosa.Behavior Modification, 11 432–463.PubMedGoogle Scholar
  4. Ben-Tovim, D. I., Walker, M. K., Fok, D., & Yap, E. (1988).An adaptation of the Stroop Test for measuring shape and food concerns in eating disorders: A quantitative measure of psychopathology? Paper presented at the Third International Conference on Eating Disorders, New York.Google Scholar
  5. Bower, G. H. (1981). Mood and memory.American Psychologist, 36 129–148.PubMedGoogle Scholar
  6. Bradley, B., & Mathews, A. (1983). Negative self-schemata in clinical depression.British Journal of Clinical Psychology, 22 173–181.Google Scholar
  7. Bruch, H. (1973).Eating disorders: Obesity, anorexia nervosa, and the person within. New York: Basic Books.Google Scholar
  8. Bruch, H. (1978).The golden cage: The enigma of anorexia nervosa. Cambridge, MA: Harvard University Press.Google Scholar
  9. Bruch, H. (1982). Psychotherapy in anorexia nervosa.International Journal of Eating Disorders, 2 3–14.Google Scholar
  10. Butler, G., & Mathews, A. (1983). Cognitive processes in anxiety.Advances in Behaviour Research and Therapy, 5 51–62.Google Scholar
  11. Button, E. (1983). Personal construct theory and psychological well-being.British Journal of Medical Psychology, 56 313–321.PubMedGoogle Scholar
  12. Cameron, N. (1974). Paranoid conditions and paranoia. In S. Arieti (Ed.),American handbook of psychiatry (2nd ed., Vol. 3). New York: Basic Books, pp. 676–693.Google Scholar
  13. Casper, R. C. (1983). Some provisional ideas concerning the psychologic structure in anorexia nervosa and bulimia. In P. L. Darby, P. E. Garfinkel, D. M. Garner, & D. V. Coscina (Eds.),Anorexia nervosa: Recent developments in research. New York: Alan R. Liss, pp. 387–392.Google Scholar
  14. Casper, R. C., & Davis, J. M. (1977). On the course of anorexia nervosa.American Journal of Psychiatry, 134 974–977.PubMedGoogle Scholar
  15. Casper, R. C., Offer, D., & Ostrov, E. (1981). The self-image of adolescents with acute anorexia nervosa.Pediatrics, 98 656–661.Google Scholar
  16. Channon, S., Hemsley, D., & de Silva, P. (1988). Selective processing of food words in anorexia nervosa.Britsh Journal of Clinical Psychology, 27 259–260.Google Scholar
  17. Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the Body Shape Questionnaire.International Journal of Eating Disorders, 6 485–494.Google Scholar
  18. Cooper, Z., Cooper, P. J., & Fairburn, C. G. (1985). The specificity of the Eating Disorders Inventory.British Journal of Clinical Psychology, 24 129–130.PubMedGoogle Scholar
  19. Crisp, A. H. (1980).Anorexia nervosa: Let me be. London: Academic Press.Google Scholar
  20. Crisp, A. H. (1983). Some aspect sof the psychopathology of anorexia nervosa. In P. L. Darby, P. E. Garfinkel, D. M. Garner, & D. V. Coscina (Eds.),Anorexia nervosa: Recent development in research. New York: Alan R. Liss, pp. 15–28.Google Scholar
  21. Crisp, A. H., & Fransella, F. (1972). Conceptual changes during recovery from anorexia nervosa.British Journal of Medical Psychology, 45 395–405.PubMedGoogle Scholar
  22. Davis, R. (1986). Assessing the eating disorders.The Clinical Psychologist, 39 33–36.Google Scholar
  23. Dykens, E. M., & Gerrard, M. (1986). Psychological profiles of purging bulimics, repeat dieters, and controls.Journal of Consulting and Clinical Psychology, 54 283–288.PubMedGoogle Scholar
  24. Epstein, S. (1973). The self-concept revisited, or a theory of a theory.American Psychologist, 28 404–416.PubMedGoogle Scholar
  25. Fairburn, C. G. (1984). Bulimia: Its epidemiology and management. In A. J. Stunkard & E. Stellar (Eds.),Eating and its disorders. New York: Raven Press, pp. 235–258.Google Scholar
  26. Fairburn, C. G. (1985). Cognitive-behavioral treatment for bulimia. In D. M. Garner & P. E. Garfinkel (Eds.),Handbook of psychotherapy for anorexia nervosa and bulimia. New York: Guilford Press, pp. 160–192.Google Scholar
  27. Fairburn, C. G. (1987).The uncertain status of the cognitive approach to bulimia nervosa. Paper presented at the Symposium on the Psychobiology of Bulimia Nervosa, Ringberg Castle, Germany.Google Scholar
  28. Fairburn, C. G., & Cooper, P. J. (1984). The clinical features of bulimia nervosa.British Journal of Psychiatry, 144 238–246.PubMedGoogle Scholar
  29. Fairburn, C. G., & Garner, D. M. (1988). Diagnostic criteria for anorexia nervosa and bulimia nervosa: The importance of attitudes to shape and weight. In D. M. Garner & P. E. Garfinkel (Eds.),Diagnostic issues in anorexia nervosa and bulimia nervosa. New York: Brunner/Mazel, pp. 36–55.Google Scholar
  30. Fiske, S. T., & Linville, P. W. (1980). What does the schema concept buy us?Personality and Social Psychology Bulletin, 6 543–557.Google Scholar
  31. Foa., E. B. (1979). Failure in treating obsessive-compulsives.Behaviour Research and Therapy, 17 169–176.PubMedGoogle Scholar
  32. Frankenburg, F., Garfinkel, P. E., & Garner, D. M. (1982). Anorexia nervosa: Issues in prevention.Journal of Preventive Psychiatry, 1 469–483.Google Scholar
  33. Fransella, F., & Button, E. (1983). The “construing” of self and body size in relation to maintenance of weight gain in anorexia nervosa. In P. L. Darby, P. E. Garfinkel, D. M. Garner, & D. V. Coscina (Eds.),Anorexia nervosa: Recent developments in research. New York: Alan R. Liss, pp. 107–116.Google Scholar
  34. Fransella, F., & Crisp, A. H. (1979). Comparisons of weight concepts in groups of neurotic, normal, and anorexic females.British Journal of Psychiatry, 134 79–86.PubMedGoogle Scholar
  35. Garber, J., & Hollon, S. D. (1988).Specificity design logic in psychopathology research: Conceptual issues and the heterogeneous versus homogeneous control controversy. Manuscript submitted for publication.Google Scholar
  36. Garner, D. M. (1986). Cognitive therapy for bulimia nervosa.Adolescent Psychiatry, 13 358–390.PubMedGoogle Scholar
  37. Garner, D. M., & Bemis, K. M. (1982). A cognitive-behavioral approach to anorexia nervosa.Cognitive Therapy and Research, 6 123–150.Google Scholar
  38. Garner, D. M., & Bemis, K. M. (1985). Cognitive therapy for anorexia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.),Handbook of psychotherapy for anorexia nervosa and bulimia. New York: Guilford Press, pp. 107–146.Google Scholar
  39. Garner, D. M., & Davis, R. (1986). The clinical assessment of anorexia nervosa and bulimia nervosa. In P. A. Keller & L. Ritt (Eds.),Innovations in clinical practice: A source book (Vol. 5). Sarasota, Florida: Professional Resource Exchange, pp. 5–28.Google Scholar
  40. Garner, D. M., Fairburn, C. G., & Davis, R. (1987). Cognitive-behavioral treatment of bulimia nervosa.Behavior Modification, 11 398–431.PubMedGoogle Scholar
  41. Garner, D. M., & Garfinkel, P. E. (1981). Body image in anorexia nervosa: Measurement, theory, and clinical implications.International Journal of Psychiatry in Medicine, 11 263–284.PubMedGoogle Scholar
  42. Garner, D. M., Olmsted, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.International Journal of Eating Disorders, 2 15–34.Google Scholar
  43. Goldfried, M. R., & Robins, C. (1983). Self-schema, cognitive bias, and the processing of therapeutic experiences. In P. C. Kendall (Ed.),Advances in cognitive-behavioral research and therapy (Vol. 2). New York: Academic Press, pp. 33–79.Google Scholar
  44. Guidano, V. F., & Liotti, G. (1983).Cognitive processes and emotional disorders. New York: Guilford Press.Google Scholar
  45. Hammen, C., Marks, T., Mayol, A., & deMayo, R. (1985). Depressive self-schemas, life stress, and vulnerability to depression:Journal of Abnormal Psychology, 94 308–319.PubMedGoogle Scholar
  46. Hollon, S. D., DeRubeis, R. J., & Evans, M. D. (1987). Causal mediation of change in treatment for depression: Discriminating between nonspecificity and noncausality.Psychological Bulletin, 102 139–149.PubMedGoogle Scholar
  47. Hollon, S. D., & Garber, J. (1988). Cognitive therapy: A social-cognitive perspective. In L. Y. Abramson (Ed.),Social cognition and clinical psychology. New York: Guilford Press, pp. 204–253.Google Scholar
  48. Hollon, S. D., & Kendall, P. C. (1981). In vivo assessment techniques for cognitive-behavioral processes. In P. C. Kendal & S. D. Hollon (Eds.),Assessment strategies for cognitive-behavioral interventions. New York: Academic Press, pp. 319–362.Google Scholar
  49. Kendall, P. C., & Ingram, R. (1987). The future for cognitive assessment of anxiety: Let's get specific. In L. Michelson & L. M. Ascher (Eds.),Anxiety and stress disorders: Cognitive-behavioral assessment and treatment. New York: Guilford Press, pp. 89–104.Google Scholar
  50. Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. I. (1950).The biology of human starvation (Vol. 2). Minneapolis: University of Minnesota Press.Google Scholar
  51. Kihlstrom, J. F., & Nasby, W. (1981). Cognitive tasks in clinical assessment: An exercise in applied psychology. In P. C. Kendall & S. D. Hollon (Eds.),Assessment strategies for cognitive-behavioral interventions. New York: Academic Press, pp. 287–317.Google Scholar
  52. Kowalski, P. S. (1986). Cognitive abilities of female adolescents with anorexia nervosa. International Journal of Eating Disorders, 5 983–997.Google Scholar
  53. Laessle, R. G., Schweiger, U., Daute-Herold, U., Schweiger, M., Fichter, M. M., & Pirke, K. M. (1988). Nutritional knowledge in patients with anorexia nervosa.International Journal of Eating Disorders, 7 63–73.Google Scholar
  54. Landau, R. J. (1980). The role of semantic schemata in phobic word interpretation.Cognitive Therapy and Research, 4 427–434.Google Scholar
  55. Landau, R. J., & Goldfried, M. R. (1981). The assessment of schemata: A unifying framework for cognitive, behavioral, and traditional assessment. In P. C. Kendall & S. D. Hollon (Eds.),Assessment strategies for cognitive-behavioral interventions. New York: Academic Press, pp. 363–399.Google Scholar
  56. Lawrence, M. (1979). Anorexia nervosa: The control paradox.Women's Studies International Quarterly, 2 93–101.Google Scholar
  57. Litz, B. T., Payne, T. J., & Colletti, G. (1987). Schematic processing of smoking information by smokers and never-smokers.Cognitive Therapy and Research, 11 301–313.Google Scholar
  58. Markus, H. (1977). Self-schemata and processing information about the self.Journal of Personality and Social Psychology, 35 63–78.Google Scholar
  59. Markus, H., Hamill, R., & Sentis, K. P. (1987). Thinking fat: Self-schemas for body weight and the processing of weight relevant information.Journal of Applied Social Psychology, 17 50–71.Google Scholar
  60. Mathews, A., & MacLeod, C. (1987). An information-processing approach to anxiety.Journal of Cognitive Psychotherapy, 1 105–115.Google Scholar
  61. Mogul, S. L. (1980). Asceticism in adolescence and anorexia nervosa.Psychoanalytic Study of the Child, 35 155–175.PubMedGoogle Scholar
  62. Mottram, M. A. (1985). Personal constructs in anorexia.Journal of Psychiatric Research, 19 291–295.PubMedGoogle Scholar
  63. Nisbett, R. E., Ross, L. (1980).Human inference: Strategies and shortcomings of social judgment. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  64. Peterson, C., Luborsky, L., & Seligman, M. E. P. (1985). Attributions and depressive mood shifts: A case study using the symptom-context method.Journal of Abnormal Psychology, 92 96–103.Google Scholar
  65. Phelan, P. W. (1987). Cognitive correlates of bulimia: The Bulimic Thoughts Questionnaire.International Journal of Eating Disorders, 6 593–607.Google Scholar
  66. Rachman, S. (1983). Irrational thinking, with special reference to cognitive therapy.Advances in Behaviour Research and Therapy, 5 63–88.Google Scholar
  67. Rampling, D. (1985). Ascetic ideals and anorexia nervosa.Journal of Psychiatric Research, 19 89–94.PubMedGoogle Scholar
  68. Ross, L. (1977). The intuitive psychologist and his shortcomings. In L. Berkowitz (Ed.),Advances in experimental social psychology (Vol. 10). New York: Academic Press, pp. 173–220.Google Scholar
  69. Ross, L., & Anderson, C. A. (1982). Shortcomings in the attribution process: On the origins and maintenance of erroneous social assessments. In D. Kahneman, P. Slovic, & A. Tversky (Eds.),Judgment under uncertainty: Heuristics and biases. Cambridge: Cambridge University Press, pp. 129–152.Google Scholar
  70. Ruderman, S. (1986). Bulimia and irrational beliefs.Behaviour Research and Therapy, 24 193–197.PubMedGoogle Scholar
  71. Rudy, T. E., & Merluzzi, T. V. (1984). Recovering social-cognitive schemata: Descriptions and applications of multidimensional scaling. In P. C. Kendall (Ed.),Advances in cognitive-behavioral research and therapy (Vol. 3), New York: Academic Press, pp. 61–102.Google Scholar
  72. Segal, Z. V. (1988). Appraisal of the self-schema construct in cognitive models of depression.Psychological Bulletin, 103 147–162.PubMedGoogle Scholar
  73. Selvini-Palazzoli, M. (1978).Self-starvation: From individual to family therapy in the treatment of anorexia nervosa (rev. ed.). New York: Jason Aronson.Google Scholar
  74. Slade, P. (1982). Toards a functional analysis of anorexia nervosa and bulimia nervosa.British Journal of Clinical Psychology, 21 167–179.PubMedGoogle Scholar
  75. Slade, P. (1985). A review of body image studies in anorexia nervosa and bulimia nervosa.Journal of Psychiatric Research, 19 255–265.PubMedGoogle Scholar
  76. Slade, P. D., & Dewey, M. E. (1986). Development and preliminary validation of SCANS: A screening instrument for identifying individuals at risk of developing anorexia and bulimia nervosa.International Journal of Eating Disorders, 5 517–538.Google Scholar
  77. Striegel-Moore, R., McAvay, G., & Rodin, J. (1986). Psychological and behavioral correlates of feeling fat in women.International Journal of Eating Disorders, 5 935–947.Google Scholar
  78. Stroop, J. R. (1935). Studies of interference in serial verbal reactions.Journal of Experimental Psychology, 18 643–662.Google Scholar
  79. Strupp, B. J., Weingartner, H., Kaye, W., & Gwirtsman, H. (1986). Cognitive processing in anorexia nervosa: A disturbance in automatic information-processing.Neuropsychobiology, 15 89–94.PubMedGoogle Scholar
  80. Taylor, S. E., & Crocker, J. (1981). Schematic bases of social information processing. In E. T. Higgins, P. Herman, & M. P. Zanna (Eds.),The Ontario Symposium in Personality and Social Psychology (Vol. 1). Hillsdale, NJ: Erlbaum, pp. 89–134.Google Scholar
  81. Thurman, J. (1982).Isak Dinesen: The life of a storyteller. New York: St. Martin's Press.Google Scholar
  82. Turk, D. C., & Salovey, P. (1985). Cognitive structures, cognitive processes, and cognitive-behavior modification: I. Client issues.Cognitive Therapy and Research, 9 1–17.Google Scholar
  83. Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and biases.Science, 185 1124–1131.Google Scholar
  84. Vitousek, K. M. B., Daly, J., & Heiser, C. (1990).The problem of self-report in the eating disorders. Manuscript submitted for publication.Google Scholar
  85. Vitousek, K. M. B., Garner, D. M., & Hollon, S. D. (1990).The assessment of cognitive processes in the eating disorders. Unpublished manuscript, University of Hawaii.Google Scholar
  86. Weinreich, P., Doherty, J., & Harris, P. (1985). Empirical assessment of identity in anorexia and bulimia nervosa.Journal of Psychiatric Research, 19 297–302.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1990

Authors and Affiliations

  • Kelly Bemis Vitousek
    • 1
  • Steven D. Hollon
    • 2
  1. 1.Department of PsychologyUniversity of HawaiiHonoluluUSA
  2. 2.Vanderbilt UniversityUSA

Personalised recommendations