Cognitive Conceptualization in ED

Core Beliefs about Value and Control

In the conceptualization of an anorexia case, deep core beliefs linking identity to the body are identified.

Frequently, the patient holds ideas such as "I am worthless," "I am unlovable," or "I am incompetent."

To compensate for this sense of inadequacy, the belief develops that absolute control over food and weight is the only way to gain value, security or admiration.

The underlying reasoning is: "If I can control my hunger and my body, then I am in control of my life and worthy of respect."

Thinness becomes a refuge from feelings of inner chaos or inadequacy.

Rigid Rules and Magical Thinking

Intermediate beliefs manifest as strict and inflexible rules.

Common examples include, "If I eat fatty foods, I will get fat immediately," "I must feel hungry to know I am doing well," or "If I skip a meal, I am strong; if I give in, I am weak."

The patient operates under all-or-nothing thinking, where any deviation from the self-imposed diet is interpreted as a total catastrophe.

In addition, magical thinking may appear where certain foods are believed to have the immediate power to visibly alter body shape after a single ingestion.

Checking and Safety Behaviors

To maintain this belief system, maintenance behavioral strategies are developed.

These include obsessive checking (weighing oneself multiple times a day, measuring body contours, pinching the skin to "detect" fat) and avoidance (wearing very loose clothing so as not to see the body, avoiding mirrors or social situations where food is present).

Misinterpretation of physiological signals is also common; for example, the natural feeling of fullness after eating is dangerously reinterpreted as "being fat" or "havi