If you have an eating disorder, such anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding and eating disorder (OSFED) you are likely experiencing problematic (and often distressing) thoughts and beliefs﻿﻿ about eating, shape, and weight, such as:

“Eating will make me feel better.”

“Eating a donut will make me fat.”

“If I don’t carefully control my diet my weight will spiral out of control.”

“I should only eat when I am truly hungry.”

Overview

On a daily basis we all process thousands of thoughts. Many of our thoughts are automatic and we don’t usually stop to examine whether they are facts or whether they are even useful.

Dysfunctional thoughts, also known as cognitive distortions—thoughts that are inaccurate and destructive—have been implicated in the maintenance of problematic eating behaviors such as restriction, bingeing, purging, and excessive exercise.﻿﻿

Treatments

Although behavioral changes are most critical to recovery from an eating disorder, cognitive-behavioral therapy (CBT), a leading treatment for eating disorders, as well as third-wave psychotherapies such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), employ strategies to help patients address thoughts that are dysfunctional.﻿﻿

Addressing Dysfunctional Thoughts

Here are some methods used by some of the more common treatment approaches to address dysfunctional thoughts.

Externalize and Defuse Your Thoughts

Before accepting your thought as a command to follow, externalize it. For example, when you have the thought, “I can’t eat a bagel,” label it as “an eating disorder thought” and rephrase it as “My eating disorder is telling me not to have a bagel.”

Once you defuse the thought﻿﻿ it becomes easier to choose a more workable course of action which may involve disobeying the eating disorder, such as, “Thank you, eating disorder, but I’m not going to listen to you. I don’t want to let my mind bully me.”

This is a strategy from acceptance and commitment therapy (ACT).

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Challenge the Thought

Ask yourself any combination of the following questions:﻿﻿

What is the evidence for that thought?

For example: “If I eat a bagel I will gain 5 pounds.” There is no evidence for this thought; a bagel could not possibly constitute enough calories to make me gain 5 pounds.

For example: “If I eat a bagel I will gain 5 pounds.” There is no evidence for this thought; a bagel could not possibly constitute enough calories to make me gain 5 pounds. What are alternative beliefs?

For example: “I shouldn’t eat unless I am truly hungry.” An alternative belief is “Since I enjoy eating with family members I need to sometimes work my mealtimes around the needs of others. This may mean eating when it is time for a meal even if I am not hungry.”

For example: “I shouldn’t eat unless I am truly hungry.” An alternative belief is “Since I enjoy eating with family members I need to sometimes work my mealtimes around the needs of others. This may mean eating when it is time for a meal even if I am not hungry.” What are the consequences of having that thought?

For example: “I’ve already blown it, so I’m going to go ahead and finish the box of cookies and start my diet tomorrow.” The consequence of this thought is that it causes me to binge which makes it worse because I end up eating even more than if I just work on accepting what I’ve already eaten.

One helpful cognitive behavioral therapy (CBT) strategy is to identify dysfunctional thoughts and replace them with facts. This can reduce distress and help with inserting more functional behaviors that support recovery.

Make a Coping Card

Take an index card and write the automatic or problematic thought on one side and the rational response on the other. This is a great strategy for those problematic thoughts that come up repeatedly. It is a good idea to review the cards daily and to keep them in your wallet. You can also pull them out whenever you find that you are having the automatic thought.

For example, a common problematic thought could be, “I’m bored. Eating will make me feel better.” On the other side of this card, write “Eating when I am bored will only make me feel worse.”

This strategy is a shortcut version of #2 above. This helpful strategy comes from Judith Beck’s Cognitive Therapy.﻿﻿

Disobey Your Eating Disorder

On a paper make a list with two columns. In one column, write, “Ed says…” and in the other column, write, “Recovery requires…” On each line under “Ed says…” write what the eating disorder tells you to do.

On the corresponding line under the “Recovery requires” column write down how you will specifically disobey that command. For example,

“Ed says skip breakfast.” “Recovery requires me to eat breakfast.”

“Ed says exercise today.” “Recovery requires me to take a day off.”

This approach stems from Life Without Ed by Jenni Schaefer and Thom Rutledge﻿﻿ and Narrative Therapy.

Run a Behavioral Experiment

Make a prediction, “If I allow myself dessert four nights this week, I will gain five pounds,” and run an experiment to test it out. Weigh yourself at the beginning and the end of the week. Have dessert four nights this week. Check to see if your prediction came true.

Over time, you will see that a number of beliefs are not accurate. This is another CBT approach.

A Word from Verywell

It is important to note that cognitive strategies alone will not usually resolve an eating disorder.﻿﻿ However, they can be an important and helpful recovery tool for many patients.

Many providers and patients also note that cognitive symptoms are often the last to improve and that recovery commonly requires behavioral change even in the face of persistent eating disorder thoughts.