Schematic Models and Modes of Mind in Anorexia Nervosa I: A Novel Process Account

A deeper understanding of the cognitive-affective mechanisms maintaining Anorexia Nervosa (AN) is required to develop more effective interventions. Clinical challenges posed by AN are reviewed and a novel model of AN is offered to account for these phenomena, framed within an established cognitive architecture (Interacting Cognitive Subsystems). It is proposed that AN is maintained by oscillations between two extreme, yet mutually reinforcing, states of mind. In ‘doing’ mode there is a focus on specific conceptual meanings about the control of eating, shape and weight, with a neglect of broader emotional meaning and bodily states associated with starvation. When control cannot be maintained, individuals move into ‘mindless bodily emoting’ mode. Here attention flips between aversive bodily sensations and emotional beliefs, resulting in feeling out of control, afraid and self-disgusted. Novel implications for course, recovery and treatment of AN following directly from this theoretical analysis are discussed in a separate sequel paper.