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Description

Anorexia nervosa, bulimia nervosa, and OEDs share a common and distinctive ‘core psychopathology. This is the over-evaluation of shape and weight and their control. This psychopathology is not usually present in binge eating disorders. It is characterized by the judging of one’s self-worth largely, or even exclusively, in terms of one’s shape and weight and one’s ability to control them. In con-trast, most people judge themselves on the basis of their perceived performance in a variety domains of life, such as their perform-ance at work, at sport, and at parenting, and the quality of their relationships. Most features of these disorders stem from the over-evaluation and its consequences. There are repeated intense feelings of fatness, and most people either closely monitor their shape or avoid seeing it altogether. The desire to control body weight leads to persistent and strict dieting, together with other forms of extreme weight control behavior, including self-induced vomiting, laxative misuse, and over-exercising. Strict dieting is highly impairing, as it requires a great deal of effort, often provokes anxiety, and can make socializing difficult, if not impossible. It may also lead to weight loss or binge eating, or both. Generally, people with an eating disorder view dieting as an ac-complishment rather than a problem. It is not something that they want to change. However, in bulimia nervosa, the strict dieting is interrupted by repeated episodes of loss of control over eating, in which large amounts of food are eaten (binges). These binges are highly aversive, and as a result, they lead people to seek help. Their help-seeking is hindered, however, by the shame and secrecy that typically accompanies binge eating.