A cognitive-behavioural theory of anorexia nervosa has recently been proposed (Fairburn, Shafran, & Cooper, 1999). This theory suggests that an extreme need to control eating is a central feature of the disorder, and that three mechanisms operate to maintain the dietary restriction. One of these maintaining mechanisms concerns the person’s interpretation of certain symptoms of starvation that result from significant weight loss. Such symptoms include abnormal attitudes and behaviour towards food and eating (e.g., preoccupation with food and eating, ritualistic eating), poor emotional and social functioning (e.g., mood liability), impaired cognitive performance (e.g., poor concentration), and physiological changes (e.g., heightened satiety) (Keys, Brozek, Henschel, Mickelsen, & Taylor, 1950). Many such symptoms are not specific to starvation but are also features of dietary restraint. The theory suggests that certain of these symptoms promote further dietary restraint by undermining the person’s sense of being in control of their eating, shape, weight or themselves in general, and that other aspects exaggerate these people’s tendency to use control over eating as an index of self-control in general.
Some of the symptoms of dietary restraint are objectively unpleasant (e.g., dizziness, hunger). Nevertheless, it is apparent clinically that some patients positively value them. Such patients seem to interpret the symptoms as a sign of being in control and as evidence that they are striving towards or achieving their goal of controlling eating, shape or weight. Although not specified in the original theory of anorexia nervosa (Fairburn et al., 1999), interpreting such symptoms as a positive sign of being in control may contribute to the maintenance of the disorder.
These hypotheses and predictions derived from the cognitive-behavioural theory of anorexia nervosa are also likely to apply to patients with bulimia nervosa and many of those with atypical eating disorders. This is for two reasons. First, as mentioned previously, many of the symptoms described are not specific to starvation but are also characteristic of attempts to restrict eating (e.g., preoccupation with food). The great majority of patients with bulimia nervosa attempt to severely restrict their food intake (Fairburn, 1997 and Russell, 1979) and the same is true of many patients with atypical eating disorders (Fairburn & Walsh, 2002) who are therefore, also likely to experience these symptoms. Second, such is the overlap between the different eating disorders in terms of their clinical features and their course over time (Fairburn, Cooper, Doll, Norman, & O’Connor, 2000), it can be argued that many of the maintaining mechanisms implicated in the maintenance of bulimia nervosa (Fairburn, 1997) and anorexia nervosa (Fairburn et al., 1999) apply across the eating disorders (Fairburn, Cooper, & Shafran, in press).
The primary aim of the present study was to test the prediction that certain symptoms of dietary restraint are interpreted by patients with eating disorders in terms of control. A second aim was to test the clinically derived hypothesis that some patients with eating disorders value these symptoms and interpret them positively. The two hypotheses were tested using an adaptation of the ambiguous scenarios paradigm (Butler and Mathews, 1983 and Cooper, 1997).
