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The Role of Denial in Eating Disorder Development, Assessment, and Treatment

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Eating Disorders

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Abstract

Denial of disordered eating (i.e., the tendency to conceal behaviors which reflect symptoms of an eating disorder) can be conscious or unconscious, ranging from lack of insight to deliberate refusal to disclose. Accordingly, denial of disordered eating may stem from various motivations such as a defense of self, shame and stigmatization, and/or fear of intervention. Denial of disordered eating is important to study and understand because it is associated with a variety of maladaptive consequences, including interpersonal conflict, suicidality, and further disordered eating. Denial of disordered eating also poses unique challenges to the assessment and treatment of eating disorders, which will be discussed within this chapter along with directions for future research.

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Abbreviations

ACT:

Acceptance and commitment therapy

CBT:

Cognitive behavior therapy

DBT:

Dialectical behavior therapy

DDEBS:

Deliberate Denial of Disordered Eating Behaviors Scale

EAT:

Eating Attitudes Test

EDI:

Eating Disorder Inventory

FBT:

Family-based therapy

NSSI:

Non-suicidal self-injury

SAI:

Schedule for the Assessment of Insight

SDBS:

Self-Disclosure about Body Satisfaction scale

SDRE:

Self-Disclosure about Restrained Eating scale

UDEBS:

Underreporting of Disordered Eating Behaviors Scale

References

  • Abbate-Daga G, Amianto F, Delsedime N et al (2013) Resistance to treatment and change in anorexia nervosa: a clinical overview. BMC Psychiatry 294(13)

    Google Scholar 

  • Ali K, Fassnacht DB, Farrer L et al (2020) What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology. Int J Eat Disord 53(6):894–906

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  • Basile B (2004) Self-disclosure in eating disorders. Eat Weight Disord 9:217–223

    Article  CAS  PubMed  Google Scholar 

  • Beck JS (2011) Cognitive behavior therapy: basics and beyond, 2nd edn. Guilford Press, New York, NY

    Google Scholar 

  • Becker AE, Eddy KT, Perloe A (2009) Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM-V. Int J Eat Disord 42(7):611–619

    Article  PubMed  Google Scholar 

  • Ben-Porath YS, Tellegen A (2011) MMPI-2-RF: manual for administration, scoring and interpretation. University of Minnesota Press, Minneapolis

    Google Scholar 

  • Butcher JN, Dahlstrom WG, Graham JR, Tellegen AM, Kaemmer B (1989) Minnesota multiphasic personality inventory-2: manual for administration, scoring, and interpretation. University of Minnesota Press, Minneapolis

    Google Scholar 

  • Chou T, Asnaani A, Hofmann SG (2012) Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups. Cult Divers Ethn Minor Psychol 18(1):74–81

    Article  Google Scholar 

  • Couturier JL, Lock J (2006) Denial and minimization in adolescents with anorexia nervosa. Int J Eat Disord 39(3):212–216

    Article  PubMed  Google Scholar 

  • Crystal DS, Ostrander R, Chen RS (2001) Multimethod assessment of psychopathology among DSM-IV subtypes of children with attention deficit/hyperactivity disorder: self, parent, and teacher reports. J Abnorm Child Psychol 29:189–205

    Article  CAS  PubMed  Google Scholar 

  • Dev P, Winzelberg J, Celio A et al (1999) Student bodies: psychoeducation communities on the web. Proc AMIA Annu:510–514

    Google Scholar 

  • Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire. Int J Eat Disord 16(4):363–370

    Article  CAS  PubMed  Google Scholar 

  • Fisher M, Schneider M, Burns J et al (2001) Differences between adolescents and young adults at presentation to an eating disorders program. J Adolesc Health 28(3):222–227

    Article  CAS  PubMed  Google Scholar 

  • Garner DM, Olmstead MP, Bohr Y et al (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878

    Article  CAS  PubMed  Google Scholar 

  • Garner DM, Olmstead MP, Polivy J (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 2(2):15–34

    Article  Google Scholar 

  • Greenfeld DG, Anyan WR, Hobart M et al (1991) Insight into illness and outcome in anorexia nervosa. Int J Eat Disord 10(1):101–109

    Article  Google Scholar 

  • Hathaway S, McKinley J (1943) Manual for administering and scoring the MMPI. University of Minnesota Press, Minneapolis

    Google Scholar 

  • Hayes SC, Luoma JB, Bond FW et al (2006) Acceptance and commitment therapy: model, processes, and outcomes. Behav Res Ther 44(1):1–25

    Article  PubMed  Google Scholar 

  • Heatherton TF, Baumeister RF (1991) Binge eating as escape from self-awareness. Psychol Bull 110(1):86–108

    Article  CAS  PubMed  Google Scholar 

  • Hooks B (1993) Sisters of the yam: black women and self-recovery. South End, Boston

    Google Scholar 

  • Howard LM, Heron KE, Cramer RJ (2019) Denial of disordered eating behaviors, suicide, and non-suicidal self-injury in young women. Death Stud 44(6):338–346

    Article  PubMed  Google Scholar 

  • Howard LM, Heron KE, Cramer RJ (2020) The deliberate denial of disordered eating behaviors scale: development and initial validation in young women with subclinical disordered eating. J Psychopathol Behav Assess 42(4):774–786

    Article  Google Scholar 

  • Howard LM, Heron KE, Veltri COC (2022) Development and initial validation of an underreporting of disordered eating behaviors scale. Eat Weight Disord Stud Anorexia, Bulimia, Obes 27:1039–1052

    Google Scholar 

  • Hunter R, Gibson C (2021) Narratives from within ‘lockdown’: a qualitative exploration of the impact of COVID-19 confinement on individuals with anorexia nervosa. Appetite 166:105451

    Article  PubMed  Google Scholar 

  • Joiner TE (2005) Why people die by suicide. Harvard University Press, Cambridge, MA

    Google Scholar 

  • Kass AE, Trockel M, Safer DL et al (2014) Internet-based preventive intervention for reducing eating disorder risk: a randomized controlled trial comparing guided with unguided self-help. Behav Res Ther 63:90–98

    Article  PubMed  PubMed Central  Google Scholar 

  • Kemp R, David A (1997) Insight and compliance. In: Blackwell B (ed) Treatment compliance and the therapeutic alliance. Harwood, Amsterdam, pp 61–84

    Google Scholar 

  • Konstantakopoulos G, Tchanturia K, Surguladze SA et al (2011) Insight in eating disorders: clinical and cognitive correlates. Psychol Med 41(9):1951–1961

    Article  CAS  PubMed  Google Scholar 

  • Konstantakopoulos G, Varsou E, Dikeos D et al (2012) Delusionality of body image beliefs in eating disorders. Psychiatry Res 200(2–3):482–488

    Article  PubMed  Google Scholar 

  • Linehan MM (2015) DBT® skills training manual, 2nd edn. Guilford Press, New York, NY

    Google Scholar 

  • Loeb KL, Lock J, Greif R et al (2019) Erratum to “Transdiagnostic theory and application of family-based treatment for youth with eating disorders”. Cogn Behav Pract 26(2):437

    Article  Google Scholar 

  • Lovejoy M (2001) Disturbances in the social body: differences in body image and eating problems among African American and White women. Gend Soc 15(2):239–261

    Article  Google Scholar 

  • Luck AJ, Morgan JF, Reid F et al (2002) “The SCOFF questionnaire and clinical interview for eating disorders in general practice: comparative study”: correction. Br Med J 325(7376):755–756

    Article  Google Scholar 

  • Masuda A, Boone MS, Timko CA (2011) The role of psychological flexibility in the relationship between self-concealment and disordered eating symptoms. Eat Behav 12(2):131–135

    Article  PubMed  Google Scholar 

  • McClay CA, Waters L, McHale C (2013) Online cognitive behavioral therapy for bulimic type disorders, delivered in the community by a nonclinician: qualitative study. J Med Internet Res 15(3):211–221

    Article  Google Scholar 

  • Michel DM (2002) Psychological assessment as a therapeutic intervention in patients hospitalized with eating disorders. Prof Psychol Res Pr 33(5):470–477

    Article  Google Scholar 

  • Newton T, Butler N, Slade P (1988) Denial of symptoms and self-report in eating disorders. Br Rev Bulimia Anorexia Nervosa 2:55–59

    Google Scholar 

  • Pettersen G, Rosenvinge JH, Ytterhus B (2008) The “double life” of bulimia: patients’ experiences in daily life interactions. Eat Disord 16(3):204–211

    Article  PubMed  Google Scholar 

  • Plateau CR, McDermott HJ, Arcelus J et al (2014) Identifying and preventing disordered eating among athletes: perceptions of track and field coaches. Psychol Sport Exer 15(6):721–728

    Article  Google Scholar 

  • Preti A, Rochhi MBL, Sisti D et al (2011) A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatr Scand 124:6–17

    Article  CAS  PubMed  Google Scholar 

  • Pryor TL, Johnson T, Wiederman MW et al (1995) The clinical significance of symptom denial among women with anorexia nervosa: another disposable myth? Eat Disord 4:293–303

    Article  Google Scholar 

  • Rieger E, van Buren DJ, Bishop M et al (2010) An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): causal pathways and treatment implications. Clin Psychol Rev 30(4):400–410

    Article  PubMed  Google Scholar 

  • Safer DL, Telch CF, Chen EY (2009) Dialectical behavior therapy for binge eating and bulimia. Guilford Press

    Google Scholar 

  • Salbach-Andrae H, Klinkowski N, Lenz K et al (2008) Correspondence between self-reported and parent-reported psychopathology in adolescents with eating disorders. Psychopathology 41(5):307–312

    Article  PubMed  Google Scholar 

  • Schoen EG, Lee S, Skow C et al (2012) A retrospective look at the internal help-seeking process in young women with eating disorders. Eat Disord 20(1):14–30

    Article  PubMed  Google Scholar 

  • Schwartz RC, Sweezy M (2020) Internal family systems therapy, 2nd edn. Guilford Press

    Google Scholar 

  • Smith AR, Zuromski KL, Dodd DR (2018) Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Curr Opin Psychol 22:63–67

    Article  PubMed  Google Scholar 

  • Starzomska M (2010) Controversial issues concerning the concept of palliative care of anorexic patients. Arch Psychiatry Psychother 12(4):49–59

    Google Scholar 

  • Starzomska M, Tadeusiewicz R (2016) Pitfalls in anorexia nervosa research: the risk of artifacts linked to denial of illness and methods of preventing them. Psychiatr Danub 28(3):202–210

    PubMed  Google Scholar 

  • Steinglass JE, Eisen JL, Attia E et al (2007) Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. J Psychiatr Pract 13(2):65–71

    Article  PubMed  Google Scholar 

  • ter Huurne ED, Postel MG, De Jong CAJ (2013) Web-based intensive therapeutic contact for eating disorders. Psychiatr Serv 64(7):711

    Article  PubMed  Google Scholar 

  • Van Orden KA, Witte TL, Cukrowicz KC et al (2010) The interpersonal theory of suicide. Psychol Rev 117:575–600

    Article  PubMed  PubMed Central  Google Scholar 

  • Vandereycken W (2006) Denial of illness in anorexia nervosa--a conceptual review: part 2 different forms and meanings. Eur Eat Disord Rev 14(5):352–368

    Article  Google Scholar 

  • Vandereycken W, Van Humbeek I (2008) Denial and concealment of eating disorders: a retrospective survey. Eur Eat Disord Rev 16(2):109–114

    Article  PubMed  Google Scholar 

  • Viglione V, Muratori F, Maestro S (2006) Denial of symptoms and psychopathology in adolescent anorexia nervosa. Psychopathology 39(5):255–260

    Article  PubMed  Google Scholar 

  • Vitousek KM, Stumpf RE (2005) Difficulties in the assessment of personality traits and disorders in eating-disordered individuals. Eat Disord 13(1):37–60

    Article  PubMed  Google Scholar 

  • Vitousek K, Daly J, Heiser C (1991) Reconstructing the internal world of the eating disordered individual: overcoming denial and distortion in self-report. Int J Eat Disord 10(6):647–666

    Article  Google Scholar 

  • Ward E, Wiltshire JC, Detry MA et al (2013) African American men and women’s attitudes toward mental illness, perceptions of stigma, and preferred coping behaviors. Nurs Res 62(3):185–194

    Article  PubMed  PubMed Central  Google Scholar 

  • Webb H, Schmidt U (2021) Facilitators and barriers to supporting young people with eating disorders during their transition to, and time at, university: an exploration of clinicians’ perspectives. Eur Eat Disord Rev 29(3):443–457

    Article  PubMed  Google Scholar 

  • Weiss CV, Mills JS, Westra HA et al (2013) A preliminary study of motivational interviewing as a prelude to intensive treatment for an eating disorder. J Eat Disord 1:34

    Article  PubMed  PubMed Central  Google Scholar 

  • Wilfley DE, Stein R, Welch R (2003) Interpersonal psychotherapy. In: Treasure J, Schmidt U, van Furth E (eds) Handbook of eating disorders, 2nd edn. Wiley, Chichester, pp 253–270

    Google Scholar 

  • Yim SH, Schmidt U (2019) Self-help treatment of eating disorders. Psychiatr Clin North Am 42(2):231–241

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychology, Augustana University, Sioux Falls, SD, USA

    Lindsay M. Howard, Anna K. Olson & Brianna N. Pitz

  2. Department of Psychology, Old Dominion University, Norfolk, VA, USA

    Kristin E. Heron

Authors
  1. Lindsay M. Howard
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  2. Anna K. Olson
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  3. Brianna N. Pitz
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  4. Kristin E. Heron
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Corresponding author

Correspondence to Lindsay M. Howard .

Editor information

Editors and Affiliations

  1. Department of Biomedical Sciences, University of Westminster, London, UK

    Vinood Patel

  2. Dept Nutrition & Dietetics, King's College London, London, UK

    Victor Preedy

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Howard, L.M., Olson, A.K., Pitz, B.N., Heron, K.E. (2022). The Role of Denial in Eating Disorder Development, Assessment, and Treatment. In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_22-1

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  • DOI: https://doi.org/10.1007/978-3-030-67929-3_22-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-67929-3

  • Online ISBN: 978-3-030-67929-3

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