Skip to main content
SpringerLink
Log in

Thought-shape fusion in bulimia nervosa: An experimental investigation

  • Original Research Paper
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

The aim of the present study was to experimentally investigate a cognitive distortion, ‘Thought Shape Fusion’ (TSF), in patients with bulimia nervosa (BN). TSF has been postulated as a specific distortion in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person’s estimate of her weight / shape, elicits a perception of moral wrongdoing and makes her feel fat. Previous psychometric measures of TSF in clinical and control groups, experiments eliciting TSF in a student sample and in patients with anorexia nervosa, all confirm a strong association between TSF and eating disorder psychopathology. Twenty patients diagnosed with BN participated in a within-participants experimental design with the aim of eliciting TSF and investigating further the possible effects of corrective behaviours (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF triggered a perception of moral wrongdoing, heightened levels of body dissatisfaction, elevated feelings of anxiety and guilt and prompted urges to engage in checking and mental neutralizing. Corrective behaviours significantly reduced the effects of the experimental procedure. Components of TSF are present in BN and are likely to play a mediating role in the maintenance of the disorder. The precise connection between TSF and BN remains to be explored in future clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Keel PK, Klump KL. Are eating disorders culturebound syndromes? Implications for conceptualizing their etiology. Psychol Bull 2003; 129: 747–69.

    Article  PubMed  Google Scholar 

  2. Keel PK, Mitchell JE. Outcome in bulimia nervosa. Am J Psychiatry 1997; 154: 313–21.

    PubMed  CAS  Google Scholar 

  3. Stice E, Shaw HE. Role of body dissatisfaction in the onset and maintenance of eating pathology. A synthesis of research findings. J Psychosom Res 2002; 53: 985–93.

    Article  PubMed  Google Scholar 

  4. Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry 1995; 152: 1073–4.

    PubMed  CAS  Google Scholar 

  5. Fairburn CG. Cognitive behavioral treatment for bulimia. In: Garner DM, Garfinkel PE (Eds) Handbook of psychotherapy for anorexia nervosa and bulimia. New York, Guildford Press, 1985, pp 160–92.

    Google Scholar 

  6. Garner DM, Bemis KM. A cognitive-behavioral approach to anorexia nervosa. Cogn Ther Res 1982; 6: 123–50.

    Article  Google Scholar 

  7. Mizes JS. Validity of the Mizes Anorectic Cognitions Scale: A comparison between anorectics, bulimics and psychiatric controls. Addictive Behav 1992; 17: 283–9.

    Article  CAS  Google Scholar 

  8. Rachman S, Shafran R. Cognitive and behavioural features of obsessive compulsive disorder. In: Swinson RP, Antony MM (Eds) Obsessive compulsive disorder: Theory, research and treatment. New York, Guilford Press, 1998, pp 51–78.

    Google Scholar 

  9. Beck AT. Cognitive therapy and the emotional disorders. New York, International University Press, 1976, pp 51–78.

    Google Scholar 

  10. Salkovskis P. Obsessional compulsive problems. Behav Res Ther 1985; 25: 579–83.

    Google Scholar 

  11. Shafran R, Thondarson DS, Rachman S. Thoughtaction fusion in obsessive-compulsive disorder. J Anxiety Disord 1996; 10: 379–91.

    Article  Google Scholar 

  12. Warwick HMC, Clark DM, Cobb AM, et al. A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry 1996; 169: 189–95.

    Article  PubMed  CAS  Google Scholar 

  13. Clark DM. A cognitive approach to panic. Behav Res Ther 1986; 24: 461–70.

    Article  PubMed  CAS  Google Scholar 

  14. Fairburn CG. Eating disorders. In: Clark DM, Fairburn CG (Eds) The science and practice of cognitive behaviour therapy. Oxford, Oxford University Press, 1997, pp 209–42.

    Google Scholar 

  15. Loeb KL, Wilson GT, Gilbert JS, et al. Guided and unguided self-help for binge eating. Behav Res Ther 2000; 38: 259–72.

    Article  PubMed  CAS  Google Scholar 

  16. Ricca V, Mannucci E, Zucchi T, et al. Cognitive-behavioral therapy for bulimia nervosa and binge eating disorder. Psychother Psychosom 2000; 69: 287–95.

    Article  PubMed  CAS  Google Scholar 

  17. Walsh BT, Wilson GT, Loeb KL, et al. Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry 1997; 154: 523–31.

    PubMed  CAS  Google Scholar 

  18. Wilson GT. Cognitive behavior therapy for eating disorders: Progress and problems. Behav Res Ther 1999; 37: S79–95.

    Article  PubMed  Google Scholar 

  19. Wilson GT, Fairburn CG. Treatments for eating disorders. In: Nathan PE, Gorman JM (Eds) A guide to treatments that work (2nd ed). New York, Oxford University Press, 2002, pp 559–93.

    Google Scholar 

  20. Rachman S. Obsessions, responsibility and guilt. Behav Res Ther 1993; 31: 149–54.

    Article  PubMed  CAS  Google Scholar 

  21. Rachman S, Shafran R, Mitchell D, et al. How to remain neutral: An experimental analysis of neutralization. Behav Res Ther 1996; 34: 889–98.

    Article  PubMed  CAS  Google Scholar 

  22. Shafran R, Robinson P. Thought-shape fusion in eating disorders. Br J Clin Psychol 2004; 43: 399–407.

    Article  PubMed  Google Scholar 

  23. Amir N, Freshman M, Ramsey B, et al. Thought-action fusion in individuals with OCD symptoms. Behav Res Ther 2001; 39: 765–76.

    Article  PubMed  CAS  Google Scholar 

  24. Rassin E, Diepstraten P, Merckelbach H, et al. Thought-action fusion and thought suppression in obsessive-compulsive disorder. Behav Res Ther 2001; 39: 757–64.

    Article  PubMed  CAS  Google Scholar 

  25. Shafran R, Rachman S. Thought-action fusion: A review. J Behav Ther Exp Psychiatry 2004; 35: 87–107.

    Article  PubMed  CAS  Google Scholar 

  26. Shafran R, Teachman BA, Kerry S, et al. A cognitive distortion associated with eating disorders: Thoughtshape fusion. Br J Clin Psychol 1999; 38: 167–79.

    Article  PubMed  Google Scholar 

  27. Radomsky AS, De Silva P, Todd G, et al. Thoughtshape fusion in anorexia nervosa: An experimental investigation. Behav Res Ther 2002; 40: 1169–77.

    Article  PubMed  Google Scholar 

  28. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed). Washington, APA, 1994.

    Google Scholar 

  29. Williamson DA, Davis CJ, Bennett SM, et al. Development of a simple procedure for body image assessment. Behav Assess 1989; 11: 433–46.

    Google Scholar 

  30. Anton SD, Perri MG, Riley JR. Discrepancy between actual and ideal body images. Impact on eating and exercise behaviors. Eat Behav 2000; 1: 153–60.

    Article  PubMed  CAS  Google Scholar 

  31. Gluck ME, Geliebter A. Racial/ethnic differences in body image and eating behaviors. Eat Behav 2002; 3: 143–51.

    Article  PubMed  Google Scholar 

  32. Williamson DA, Barker SE, Bertman LJ, et al. Body image, body dysphoria, and dietary restraint: Factor structure in non-clinical subjects. Behav Res Ther 1995; 33: 85–93.

    Article  PubMed  CAS  Google Scholar 

  33. Williamson DA, Gleaves DH, Watkins PC, et al. Validation of self-ideal body size discrepancy as a measure of body dissatisfaction. J Psychopathol Behav Assess 1993; 15: 57–68.

    Article  Google Scholar 

  34. Heatherton TF, Herman CP, Polivy J. Effects of physical threat and ego threat on eating behavior. J Pers Soc Psychol 1991; 60: 138–43.

    Article  PubMed  CAS  Google Scholar 

  35. Heatherton TF, Baumeister RF. Binge eating as escape from self-awareness. Psychol Bull 1991; 110: 86–108.

    Article  PubMed  CAS  Google Scholar 

  36. Alpers GW, Tuschen-Caffier B. Negative feelings and the desire to eat in bulimia nervosa. Eat Behav 2001; 2: 339–52.

    Article  PubMed  CAS  Google Scholar 

  37. Ganley RM. Emotion and eating in obesity: A review of the literature. Int J Eat Disord 1989; 8: 343–61.

    Article  Google Scholar 

  38. Ruderman AJ. Restraint and irrational cognitions. Behav Res Ther 1985; 23: 557–61.

    Article  PubMed  CAS  Google Scholar 

  39. Davis R, Freeman RJ, Garner DM. A naturalistic investigation of eating behavior in bulimia nervosa. J Consult Clin Psychol 1988; 56: 273–9.

    Article  PubMed  CAS  Google Scholar 

  40. Kaye WH, Gwirtzman HE, George DT, et al. Relationship of mood alterations to bingeing behavior in bulimia. Br J Psychiatry 1986; 149: 479–85.

    Article  PubMed  CAS  Google Scholar 

  41. Steinberg S, Tobin D, Johnson C. The role of bulimic behaviours in affect regulation: Different functions for different patient subgroups? Int J Eat Disord 1989; 9: 51–5.

    Article  Google Scholar 

  42. Cattarin JA, Thomson JK. A three-year longitudinal study of body image, eating disturbance, and general psychological functioning in adolescent females. Eat Disord 1994; 2: 114–25.

    Article  Google Scholar 

  43. Stice E, Agras WS. Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behav Ther 1998; 29: 257–76.

    Article  Google Scholar 

  44. Rassin E. The contribution of thought-action fusion and thought suppression in the development of obsession- like intrusions in normal participants. Behav Res Ther 2001; 39: 1023–32.

    Article  PubMed  CAS  Google Scholar 

  45. Shafran R, Lee M, Payne E, et al. An experimental analysis of body checking. Behav Res Ther 2007; 45: 113–21.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Rachman S, De Silva P, Roper G. Spontaneous decay of compulsive urges. Behav Res Ther 1976; 14: 445–53.

    Article  PubMed  CAS  Google Scholar 

  47. Bruch H. Perceptual and conceptual disturbances in anorexia nervosa. Psychosom Med 1962; 24: 187–94.

    PubMed  CAS  Google Scholar 

  48. Cash TF, Deagle EA. The nature and extent of bodyimage disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. Int J Eat Disord 1997; 22: 107–25.

    Article  PubMed  CAS  Google Scholar 

  49. Fairburn CG, Shafran R, Cooper Z. A cognitive behavioural theory of anorexia nervosa. Behav Res Ther 1999; 37: 1–13.

    Article  PubMed  CAS  Google Scholar 

  50. Mizes JS, Christiano BA. Assessment of cognitive variables relevant to cognitive behavioral perspectives in anorexia nervosa and bulimia nervosa. Behav Res Ther 1995; 33: 95–105.

    Article  PubMed  CAS  Google Scholar 

  51. Williamson DA, Muller SL, Reas DL, et al. Cognitive bias in eating disorders: Implications for theory and treatment. Behavior Modification 1999; 23: 556–77.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Panteion University, Athens, 11 Kyprou street, Kifissia, 145 62, Greece

    M. Kostopoulou & A. Stalikas

  2. Eating Disorders Outpatient Clinic, Eginition Hospital, University of Athens Department of Psychiatry, Athens, Greece

    E. Varsou

Authors
  1. M. Kostopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Varsou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Stalikas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Kostopoulou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kostopoulou, M., Varsou, E. & Stalikas, A. Thought-shape fusion in bulimia nervosa: An experimental investigation. Eat Weight Disord 16, e86–e92 (2011). https://doi.org/10.3275/7361

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.3275/7361

Key words

Search

Navigation