Cognitive Bias in Eating Disorders: Implications for Theory and Treatment
Abstract
Research testing the predictions of cognitive-behavioral theory related to the psychopathology of eating disorders has lagged behind treatment outcome research. Central to cognitive theories of eating disorders is the hypothesis that beliefs and expectancies pertaining to body size and to eating are biased in favor of selectively processing information related to fatness/thinness, dieting, and control of food intake or body weight. In recent years, controlled investigations of the predictions of cognitive theories of eating disorders have yielded empirical support for these theories. This paper reviews research which has tested the predictions of cognitive-behavioral theory and discusses the implications of these findings for the treatment of eating disorders. Understanding of information processing biases may assist the clinician in understanding a range of psychopathological features of anorexia and bulimia nervosa, including denial, resistance to treatment, and misinterpretation of therapeutic interventions.
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Appearance-centered focus can result in cognitive biases, such as paying more attention to appearance-related information.
“Scholars indicate that this appearance-centered focus can result in cognitive biases, such as paying more attention to appearance-related information (see Williamson, Muller, Reas, & Thaw, 1999, for a review), and can prompt individuals to wonder how their appearance compares to others (Lindner, Tantleff-Dunn, & Jentsch 2012).”
From The reciprocal and indirect relationships between passive Facebook use, comparison on Facebook, and adolescents' body dissatisfaction (2017) · cites this paper as Williamson et al., 1999
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Bower, G. H. (1981) · American Psychologist · doi:10.1037//0003-066x.36.2.129 · Cited by 5,798 · see citing works
Bower, G. H. (1981) · American Psychologist · doi:10.1037/0003-066x.36.2.129 · Cited by 4,154 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Raber, G., & Spokas, M. (2024) · doi:10.4135/9781071886229.n145 · Cited by 2,806 · see citing works
Frijda, N. H. (1988) · American Psychologist · doi:10.1037//0003-066x.43.5.349 · Cited by 2,611 · see citing works
The emotional Stroop task and psychopathology
Williams, J. M. G., Mathews, A., & MacLeod, C. (1996) · Psychological Bulletin · doi:10.1037/0033-2909.120.1.3 · Cited by 2,420 · see citing works
The development and validation of the body shape questionnaire
Cooper, P., Taylor, M., Cooper, Z., & Fairbum, C. G. (1987) · International Journal of Eating Disorders · doi:10.1002/1098-108x(198707)6:4 · Cited by 2,178 · see citing works
Binge eating: nature, assessment, and treatment
(1994) · Choice Reviews Online · doi:10.5860/choice.31-4640 · Cited by 1,801 · see citing works
Frijda, N. H. (1988) · American Psychologist · doi:10.1037/0003-066x.43.5.349 · Cited by 1,533 · see citing works
Binge Eating: Nature, Assessment and Treatment
Hanson, K., & Pasulka, P. S. (1994) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/014860719401800419 · Cited by 1,166 · see citing works
International Journal of Eating Disorders
(2006) · doi:10.1002/(issn)1098-108x · Cited by 1,147 · see citing works
Progress in Behavior Modification
Hersen, M., & Eisler, R. M. (1983) · Cited by 1,020 · see citing works
Selective processing of threat cues in anxiety states
Mathews, A., & MacLeod, C. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90104-4 · Cited by 1,001 · see citing works
Body Images: Development, Deviance, and Change
Levy, N. B. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.3.401-b · Cited by 877 · see citing works
Eating disorders and obesity : a comprehensive handbook
Brownell, K. D., & Fairburn, C. G. (1995) · Guilford Press eBooks · Cited by 766 · see citing works
Canadian Journal of Psychiatry
(1979) · The Canadian Journal of Psychiatry · doi:10.1177/070674377902400508 · Cited by 762 · see citing works
Perceptual and Conceptual Disturbances in Anorexia Nervosa
Bruch, H. (1962) · Psychosomatic Medicine · doi:10.1097/00006842-196203000-00009 · Cited by 760 · see citing works
Cash, T. F., Pruzinsky, T., Grazer, F. M., & Sorensen, C. L. (1991) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199108000-00041 · Cited by 665 · see citing works
Attentional bias in anxiety and depression: The role of awareness
Mogg, K., Bradley, B. P., & Williams, R. (1995) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1995.tb01434.x · Cited by 559 · see citing works
Agius, M. (1996) · University of Malta. Department of Psychiatry eBooks · Cited by 528 · see citing works
The investigation of schematic content and processing in eating disorders
Vitousek, K. B., & Hollon, S. D. (1990) · Cognitive Therapy and Research · doi:10.1007/bf01176209 · Cited by 507 · see citing works
Progress in behavior modification
John, C. H. (1992) · Behaviour Research and Therapy · doi:10.1016/0005-7967(92)90059-p · Cited by 469 · see citing works
Colour naming of phobia‐related words
Watts, F., MCKENNA, F. P., Sharrock, R., & Trezise, L. (1986) · British Journal of Psychology · doi:10.1111/j.2044-8295.1986.tb01985.x · Cited by 452 · see citing works
Eating disorders and obesity. A comprehensive handbook
Hay, P. (1996) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)90035-5 · Cited by 431 · see citing works
Awareness of body dimensions in anorexia nervosa: cross-sectional and longitudinal studies
Slade, P. D., & RUSSELL, G. F. M. (1973) · Psychological Medicine · doi:10.1017/s0033291700048510 · Cited by 408 · see citing works
Cognitive-behavioral body image therapy for body dysmorphic disorder
Rosen, J. C., Reiter, J., & Orosan, P. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.63.2.263 · Cited by 384 · see citing works
Body Image in Anorexia Nervosa: Measurement, Theory and Clinical Implications
Garner, D. M., & Garfinkel, P. E. (1982) · The International Journal of Psychiatry in Medicine · doi:10.2190/r55q-2u6t-lam7-rqr7 · Cited by 356 · see citing works
Body Image in Anorexia Nervosa and Bulimia Nervosa
Cash, T. F., & Brown, T. A. (1987) · Behavior Modification · doi:10.1177/01454455870114005 · Cited by 283 · see citing works
Interpretation of homophones related to threat in anxiety states.
Mathews, A., Richards, A., & Eysenck, M. W. (1989) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.98.1.31 · Cited by 275 · see citing works
Cross-cultural aspects of anorexia nervosa and bulimia: A review
Dolan, B. M. (1991) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199101)10:1 · Cited by 275 · see citing works
Allison, D. B. (1995) · Medical Entomology and Zoology · Cited by 271 · see citing works
Killen, J. D., Taylor, C. B., Hammer, L. D., Litt, I. F., Wilson, D. M., Rich, T., Hayward, C., Simmonds, B., KRAEMER, H. C., & Varady, A. N. (1993) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199305)13:4 · Cited by 245 · see citing works
Bulimia nervosa: Treatment with exposure and response prevention
Rosen, J. C., & Leitenberg, H. (1982) · Behavior Therapy · doi:10.1016/s0005-7894(82)80055-5 · Cited by 237 · see citing works
Sensitivity to feared stimuli in obsessive-compulsives: A dichotic listening analysis
Foa, E. B., & McNally, R. J. (1986) · Cognitive Therapy and Research · doi:10.1007/bf01173299 · Cited by 209 · see citing works
Interpretation of homophones related to threat in anxiety states.
Mathews, A., Richards, A., & Eysenck, M. W. (1989) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.98.1.31 · Cited by 193 · see citing works
Assessment of eating disorders: obesity, anorexia, and bulimia nervosa
(1990) · Choice Reviews Online · doi:10.5860/choice.27-6631 · Cited by 171 · see citing works
Bracalente, J. (1986) · American Journal of Occupational Therapy · doi:10.5014/ajot.40.3.211a · Cited by 149 · see citing works
A review of body-image studies in anorexia nervosa and bulimia nervosa
Slade, P. (1985) · Journal of Psychiatric Research · doi:10.1016/0022-3956(85)90026-3 · Cited by 140 · see citing works
Selective processing of eating-, shape-, and weight-related words in persons with bulimia nervosa.
Cooper, M. J., Anastasiades, P., & Fairburn, C. G. (1992) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.101.2.352 · Cited by 124 · see citing works
Sourcebook of Psychological Treatment Manuals for Adult Disorders
Hasselt, V. B. V., & Hersen, M. (1996) · Springer eBooks · doi:10.1007/978-1-4899-1528-3 · Cited by 123 · see citing works
Processing of emotional information in anxious subjects
Mogg, K., & Marden, B. (1990) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1990.tb00874.x · Cited by 119 · see citing works
Body image disturbance in eating disorders: A form of cognitive bias?
Williamson, D. A. (1996) · Eating Disorders · doi:10.1080/10640269608250075 · Cited by 113 · see citing works
Self-citationBody image disturbance, memory bias, and body dysphoria: Effects of negative mood induction
Baker, J. D., Williamson, D. A., & Sylve, C. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80043-7 · Cited by 108 · see citing works
Self-citationEquivalence of body image disturbances in anorexia and bulimia nervosa.
Williamson, D. A., Cubic, B. A., & Gleaves, D. H. (1993) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.102.1.177 · Cited by 101 · see citing works
Self-citationBurgess, I. S., Jones, L., Robertson, S. A., Radcliffe, W., & Emerson, E. (1981) · Behaviour Research and Therapy · doi:10.1016/0005-7967(81)90007-3 · Cited by 95 · see citing works
Selective processing of eating-, shape-, and weight-related words in persons with bulimia nervosa.
Cooper, M. J., Anastasiades, P., & Fairburn, C. G. (1992) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.101.2.352 · Cited by 95 · see citing works
Memory bias for fatness stimuli in the eating disorders
Sebastian, S. B., Williamson, D. A., & Blouin, D. C. (1996) · Cognitive Therapy and Research · doi:10.1007/bf02229238 · Cited by 86 · see citing works
Self-citationHandbook of Psychological Treatment Protocols for Children and Adolescents
Hasselt, V. B. V., & Hersen, M. (1998) · Routledge eBooks · doi:10.4324/9781410601957 · Cited by 69 · see citing works
Handbook of Child Behavior Therapy
Watson, T. S., & Gresham, F. M. (1998) · Issues in clinical child psychology · doi:10.1007/978-1-4615-5323-6 · Cited by 67 · see citing works
Stable and reactive body image disturbances in bulimia nervosa
McKenzie, S. J., Williamson, D. A., & Cubic, B. A. (1993) · Behavior Therapy · doi:10.1016/s0005-7894(05)80263-1 · Cited by 66 · see citing works
Self-citationThe addiction model in eating disorders: Some critical remarks and a selected bibliography
Vandereycken, W. (1990) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199001)9:1 · Cited by 66 · see citing works
Body image, body dysphoria, and dietary restraint: Factor structure in nonclinical subjects
Williamson, D. A., Barker, S. E., Bertman, L. J., & Gleaves, D. H. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)e0031-d · Cited by 62 · see citing works
Self-citationCognitive—Behavioral Treatment of Body-Image Disturbances
Cash, T. F., & Grant, J. R. (1996) · Springer eBooks · doi:10.1007/978-1-4899-1528-3_15 · Cited by 55 · see citing works
Behavioral assessment of satiety in bulimia nervosa
Hadigan, C. M., Walsh, B. T., Devlin, M. J., LaChaussée, J. L., & Kissileff, H. R. (1992) · Appetite · doi:10.1016/0195-6663(92)90200-p · Cited by 55 · see citing works
Repeated binge/purge cycles in bulimia nervosa: Role of glucose and insulin
Johnson, W. G., Jarrell, M. P., Chupurdia, K. M., et al. (1994) · International Journal of Eating Disorders · doi:10.1002/eat.2260150404 · Cited by 54 · see citing works
Do weight-preoccupied women misinterpret ambiguous stimuli related to body size?
Jackman, L. P., Williamson, D. A., Netemeyer, R. G., & Anderson, D. A. (1995) · Cognitive Therapy and Research · doi:10.1007/bf02230404 · Cited by 52 · see citing works
Self-citationBody size distortion in bulimia nervosa
Willmuth, M. E., Fondacaro, K. M., Gross, J., Leitenberg, H., & Rosen, J. C. (1985) · International Journal of Eating Disorders · doi:10.1002/1098-108x(198502)4:1 · Cited by 47 · see citing works
Assessment of eating disorders: obesity, anorexia and bulimia nervosa
Gowers, S. (1991) · Journal of Adolescence · doi:10.1016/0140-1971(91)90040-x · Cited by 47 · see citing works
Oral and dental characteristics in bulimic and anorectic patients
Philipp, E., Willershausen-Zönnchen, B., Hamm, G., & Pirke, K. (1991) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199107)10:4 · Cited by 46 · see citing works
Confirmatory factor analysis of a multidimensional model of bulimia nervosa.
Gleaves, D. H., Williamson, D. A., & Barker, S. E. (1993) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.102.1.173 · Cited by 46 · see citing works
Self-citationCognitive Behavior Therapy for Eating Disorders
Williamson, D. A., Womble, L. G., & Zucker, N. L. (1998) · Issues in clinical child psychology · doi:10.1007/978-1-4615-5323-6_17 · Cited by 43 · see citing works
Self-citationThe influence of context on lexical decision times for emotionally aversive words
Hill, A. B., & Kemp-Wheeler, S. M. (1989) · Current Psychology · doi:10.1007/bf02686750 · Cited by 37 · see citing works
What Can Be Learned from Body Size Estimation? It All Depends on Your Theory
Smeets, M. A. M., & Panhuysen, G. E. M. (1995) · Eating Disorders · doi:10.1080/10640269508249153 · Cited by 32 · see citing works
Bulimia, dietary restraint, and concern for dieting
Duchmann, E. G., Williamson, D. A., & Stricker, P. M. (1989) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/bf00962695 · Cited by 30 · see citing works
Self-citationEgo functioning in eating disorders: Description and relation to diagnostic classification
Norring, C. E. A., Sohlberg, S., Rosmark, B., Humble, K., Holmgren, S., & Nordqvist, C. (1989) · International Journal of Eating Disorders · doi:10.1002/1098-108x(198911)8:6 · Cited by 29 · see citing works
Dissociation, childhood trauma, and the response to fluoxetine in bulimic patients
McCarthy, M. K., GOFF, D. C., Baer, L., Cioffi, J., & Herzog, D. B. (1994) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199404)15:3 · Cited by 25 · see citing works
(2021) · MDPI eBooks · doi:10.3390/books978-3-0365-0517-6 · Cited by 22 · see citing works
Biased perception of overeating in bulimia nervosa and compulsive binge eaters
Williamson, D. A., Gleaves, D. H., & Lawson, O. J. (1991) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/bf00960788 · Cited by 20 · see citing works
Self-citationWilliamson, D. A., Sebastian, S. B., & Varnado, P. J. (1995) · Plenum series in rehabilitation and health · doi:10.1007/978-1-4899-1028-8_9 · Cited by 13 · see citing works
Self-citationInterpretation of Ambiguous Body-Related Stimuli in the Eating Disorders.
Perrin, L. A. (1995) · doi:10.31390/gradschool_disstheses.6125 · Cited by 3 · see citing works
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- Authors
- Williamson, D. A., Muller, S. L., Reas, D. L., & Thaw, J. M.
- Affiliations
- Louisiana State University (US)
- ORCID
- Reas, Deborah L.
- Venue
- Behavior Modification
- Publisher
- SAGE Publications
- Published
- 1999-10
- Volume
- 23
- Issue
- 4
- Pages
- 556-577
- ISSN
- 0145-4455 (ISSN-L)
- 1552-4167
- OpenAlex
- W2152012714
- Cited by
- 210
- References
- 71
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 3 · 2023: 9 · 2022: 7 · 2021: 4 · 2020: 10 · 2019: 2 · 2018: 10 · 2017: 9 · 2016: 7 · 2015: 17 · 2014: 8 · 2013: 8 · 2012: 11
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Modification (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive biases, eating disorders, cognitive-behavioral theory, anorexia nervosa, bulimia nervosa, eating expectancies, information processing biases, treatment resistance, denial
- MeSH terms
- Feeding and Eating Disorders, Attitude, Body Constitution, Body Image, Defense Mechanisms, Humans, Models, Psychological, Obsessive Behavior, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy
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