The Dirty Dozen: Cognitive Distortions in Eating Disorders

The so called dirty dozen encompasses a set of cognitive distortions related to body image. They’re extremely common, unfair and deeply limiting.

Written and verified by the psychologist José Padilla.

Last update: 27 November, 2022

Cognitive distortions about food, weight, and body image are an evident problem in eating disorders (EDs). According to the cognitive model, these dysfunctional or irrational thoughts affect how the patient feels about their physical appearance. Therefore, the problem lies, not in their body, but in the thoughts and feelings derived from the image they have of it.

The psychologist, Thomas F. Cash took up the set of cognitive distortions that Aaron Beck and Albert Ellis proposed and reworked them in relation to eating disorders, developing a set of cognitive errors regarding appearance. These distorted thoughts were dubbed the dirty dozen.

The dirty dozen: cognitive distortions in eating disorders

Eating disorders are characterized by a set of irrational and persistent thoughts about food, weight, and body image. The distortions known as the dirty dozen relate to body image. Let’s find out what they are and how to deal with them.

1. Beauty or the beast

This is a dichotomous thought that moves between two poles: beauty and ugliness. The individual assumes that if they’re not beautiful, then they’re ugly. The continuum between the two poles is blurred, and it becomes bipolarized.

It’s an all-or-nothing type of thought, a black-or-white viewpoint with no room for any grey. This distortion is evident in expressions such as: “I’m either attractive or I’m ugly” or “I’m either thin or I’m fat”. If you’re experiencing this kind of cognitive distortion you should:

• Be cognitively flexible. This ability helps you to develop understanding and empathy for yourself. It also teaches you how to deal with problems in a tolerant and adaptive way.
• Remember that not everything is black and white. You should use a scale from one to ten to assess your body image. You shouldn’t consider your body as a whole but in parts. For example, you should think of what you like about your body. Also, think of everything you can do with your body and recognize it as the marvelous feat of engineering it is.
• Conduct a behavioral experiment. Go out into the street and observe all the different kinds of bodies there are out there.

2. The unreal ideal

This cognitive distortion consists of the sufferer evaluating their own appearance from an ideal standard model. Consequently, they perceive themselves as imperfect. In fact, they see themselves as fatter or uglier in relation to the ideal model with which they compare themselves.

Social media can be extremely influential when it comes to assessing body image. To deal with this dysfunctional thinking, you should:

• Try not to visit the social media profiles of the people with whom you physically compare yourself.
• Find a new model, but don’t focus on their physical appearance. Instead, concentrate on the virtues you can learn from them.

3. The unfair comparison

This occurs when the sufferer only compares themselves to those who have the physical characteristics that they’d like to have. For example, they might use expressions like “I should be as thin as X” or “I wish I had their muscles”.

These comparisons are always ascending. In other words, they only occur with those people who they consider to be better, not worse (descending comparison). If  this is your problem you should:

• Keep track of when and where you compare yourself the most and look for new options that focus your attention on other aspects.
• Try not to compare yourself with others. If you do, make sure you do it in a fair or descending way. In effect, you should look for a comparison where you win.

4. The magnifying glass

This consists of the individual directing their attention to negative characteristics or imperfections of their physical appearance, exaggerating them, and perceiving them in dimensions that don’t exist. For example, saying things like “My legs are too fat and they make me look so ugly”. In effect, they don’t see their positive aspects but only those that are judged pejoratively. If you’re guilty of this kind of distortion you should:

• Take some time to notice the pleasant aspects of yourself. Make a list of them and visualize them with your eyes closed. Then, expand the pleasant sensation that you experience toward those parts of your body to the other parts you’re dissatisfied with.
• Distribute your attention to other things instead of the parts of you that you don’t like. Do activities that don’t focus your concentration on them.

5. The blind mind

This dysfunctional thinking is based on minimizing or ignoring the positive parts of body image. For example, sufferers might say “You tell me that my legs are beautiful, but you’re only saying it to make you look good” or “He says my nose is nice but that’s only because he’s my boyfriend” or “My ears make me look so ugly” (said by an attractive woman). If this sounds like you, you should:

• Receive and accept with love the positive comments that others make about you. Don’t ignore or minimize them.
• Take care of the parts of yourself that you like and that you’ve neglected due to concentrating on those that you dislike.

6. Misunderstanding of the mind

This refers to when an individual considers that others observe them the way they perceive themselves. They believe that they can read or interpret the actions and ideas of others in relation to some unpleasant aspect of their body image. For example, “I don’t have a partner because I’m so fat”, or “I know everyone thinks I’m ugly”. If this is you, you should:

• Remember that what you think others assume of you is a projection you make of the way you perceive yourself.
• Bear in mind that people aren’t looking at you and your body all the time.

7. Radiating ugliness

This is the spread of dissatisfaction with one part of the body to other parts. Disgust spreads like a shock wave throughout the body. It’s like when a stone is thrown into a lake. The ripples increasingly spread over the entire surface of the water.

The same happens with non-conformity with body image. For example, “How can I be anything but awful with arms like this?” or  “My ugly nose and double chin spoil my whole face”. If you’re a victim of these kinds of thoughts you should:

• Make sure you don’t spend so much time looking at yourself in the mirror.
• Focus on the parts of yourself that you like and prevent the shock wave of dissatisfaction from reaching them.

8. The blame game

This occurs when the individual attributes any negative event to the part of their physical appearance with which they feel dissatisfied.

For example, they might assume that their friends didn’t invite them to a party because they’re so overweight. Or, that their cousins don’t want to go out with them because their ears are too big. In effect, they make an arbitrary inference without having a valid basis to support it. If you’re a victim of this kind of behavior, you should:

• Ask yourself what other reasons there could be to explain what happened. Is it really all down to you?
• Take a step back from your thoughts and examine them critically. Don’t believe everything they tell you.

9. The prediction of misfortune

This involves predicting misfortunes based on body image. For instance, saying “I’m sure they’d never go out with me because I’m so ugly.” In the end, this type of future visualization becomes a reality. In other words, they become self-fulfilling prophecies. If you’re guilty of this, you should:

• Examine what you can do to make things better.
• Visualize the event in a positive way.
• Avoid making pessimistic prophecies.

10. Limiting beauty

This is the tendency to believe that appearance imposes a series of limits on what we can do. For example, “That shirt won’t fit me until my arms are thinner.” This way of thinking is extremely limiting, thus turning body image into an obstacle to enjoying life. If this is you, you should:

• Ask yourself how your body image might be limiting you.
• Stop limiting your life due to how you look. If you don’t feel good in one swimsuit, use another, but don’t stop enjoying the sun, the sea, and the beach just because you think you can’t wear the perfect bikini.

11. The thought of feeling ugly

This involves turning a belief into an absolute truth. For example “I feel ugly so I must be.” The individual assumes that their thoughts are a faithful copy of reality and not a simple hypothesis about it. If you’re guilty of this, you should:

• Recognize that when you feel a certain way or think a certain way, you’re seeing reality from that perspective. However, in reality, it’s not necessarily that way.
• Make a record of other people’s comments that aren’t aligned with your perception.

12. The bad mood reflection

In this cognitive distortion, the concerns or the bad mood generated by any event are transferred to the body itself. For instance, a stressful day at work or school ends up being attributed to appearance. The individual thinks that with another body they wouldn’t have to face those negative events. If you feel like this:

• Do an activity that helps you de-stress. If you’re angry, listen to your emotion and accept it. Under no circumstances, attribute to your body what you’re feeling because of something else.

These dirty dozen cognitive distortions affect the way sufferers of eating disorders perceive reality, themselves, and their bodies. They’re like a kind of filter that eventually ends up confirming the assumptions that they have and all their irrational beliefs. If you’ve identified any of these distortions in relation to your own body image, try and figure out how your way of perceiving yourself has affected your relationship with your body.