How do eating disorders affect people's thoughts?

Dr. Michael Roizen, MD
Internal Medicine

Eating disorders in their extreme form seem to burrow into the brains of their victims, take over their thoughts and grow stronger every day. People with eating disorders build a “fat box,” where every comment, every situation, is filtered through the box and distorted, so that it comes out as a criticism or demand. “You look great today” becomes “You usually look fat.” “You look so healthy” becomes “You’re eating too much.” “I love your hair” becomes “I can’t find anything nice to say about the rest of you.”

EDs also take over their victims’ self-perceptions. People become unable to see the “real” image of themselves in the mirror, seeing someone much larger or  with a distorted body shape. People with severe eating disorders often go to sleep thinking about food and wake up thinking about food. Every bite is an internal struggle. The “eating disorder voice” grows to be much louder than the individual’s true voice, and constantly berates and threatens. “You are a fat pig with no control!” “If you eat that cookie, you’re going to be totally disgusting!”

YOU: The Owner's Manual for Teens: A Guide to a Healthy Body and Happy Life

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YOU: The Owner's Manual for Teens: A Guide to a Healthy Body and Happy Life

A few years ago, we wrote YOU: The Owner’s Manual, which taught people about the inner workings of their bodies—and how to keep them running strong. But you know what? There’s a big difference...
Vicki Berkus, MD

It is very interesting to watch the change in ability to think clearly as the re-feeding process continues in anorexic patients. In the beginning phase (precontemplation), the patient doesn't believe they have a problem and they are obsessed with not gaining weight and it is the norm to not believe the nutritionist or the treatment team. Their thoughts are focused on the food, their fear and the idea that they will not let themselves gain weight. This distrust and narrow focus takes a lot of patience and time to work through. The bulimic patient describes a "fog" where they start thinking about what they are going to eat or binge on and where can they safely purge. It takes over their thoughts and it is hard to focus on the task at hand. There can be shortened attention span, decreased memory and confusion with all types of eating disorders. The need to be perfect and follow all their rules around food carries over to their relationships, work and ability to enjoy normal everyday tasks. The bulimic may be more impulsive and engage in substance abuse or other behaviors which add to their decreased cognitive function.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.