Abstract
Objective: The study explored the semantic content and origins of negative self-beliefs, and their functional links to “not eating enough” and other behaviors, in participants with anorexia nervosa (AN). Method: Fifteen women meeting DSM-IV criteria for AN were compared with 17 dieting and 18 non-dieting women matched on age and number of years of education. The main outcome measure was a semi-structured interview. Results: Six themes were identified in the beliefs of participants with AN. These were, in order of decreasing frequency, powerlessness (present in all but three AN participants), failure, defectiveness, unattractiveness, worthlessness and emptiness. Importantly, powerlessness and failure beliefs were consistently present independent of Beck Depression Inventory-II scores. The negative early life experiences associated with these beliefs had high distress and responsibility ratings. Participants with AN reported that they employed specific behaviors, particularly ‘not eating enough,’ and ‘placating others,’ to try to reduce the cognitive and emotional impact of their negative self-beliefs. Discussion: The findings are discussed in relation to the role of powerlessness and the function of “not eating enough” in cognitive theory and therapy for AN.
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Notes
We use the term “not eating enough” to describe the key behavioral feature of AN, rather than dieting or restricting as others have sometimes done. This reflects our belief that “not eating” is the key feature, and that it is distinctively and qualitatively different from both these other behaviors (as bingeing is from overeating). Our clinical experience is that patients also report a qualitative difference and make a similar distinction when describing the key features of their problematic AN behavior.
We choose to use the term ‘powerlessness’ as it seems that patients use this term more than ‘personal ineffectiveness,’ and the use of the word ‘control’ seems to us to be ambiguous (see below).
It is interesting to note, however, that Serfaty suggests that enhanced personal effectiveness may be an important mechanism effecting change in his study of CBT for AN (Serfaty et al., 1999).
Rationally=extent to which you believe this rationally, when considering all the evidence; emotionally=extent to which you feel that this is true, regardless of the evidence.
Body Mass Index (BMI): weight (kg)/height (m2).
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Woolrich, R.A., Cooper, M.J. & Turner, H.M. A Preliminary Study of Negative Self-Beliefs in Anorexia Nervosa: A Detailed Exploration of Their Content, Origins and Functional Links to “Not Eating Enough” and Other Characteristic Behaviors. Cogn Ther Res 30, 735–748 (2006). https://doi.org/10.1007/s10608-006-9024-y
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DOI: https://doi.org/10.1007/s10608-006-9024-y