• thought-shape fusion;
  • cognitive distortion;
  • over-evaluation of food;
  • eating disorders;
  • subtypes



Over-evaluation of food, shape and weight is a multi-faceted component of cognitive-behavioral models of eating disorders. One specific aspect of over-evaluation of food is a cognitive distortion known as thought-shape fusion (TSF). TSF is purported to be specific to eating pathology; however, research has not yet elucidated whether individuals across the subtypes of eating disorders are differentially susceptible to this phenomenon. Furthermore, it remains unclear whether susceptibility to TSF decreases over the course of treatment.


TSF, eating pathology, and generalized psychopathology were assessed in 76 individuals with eating disorders. Changes in TSF from pre- to post-treatment were assessed in a subset of participants (n = 24).


Individuals with the binge/purge subtype of anorexia nervosa were more susceptible to TSF than were individuals with bulimia nervosa or the restrictive subtype of anorexia nervosa. Increased TSF corresponded with higher levels of eating pathology, depression, and impulsivity. In addition, there were decreases in TSF over the course of treatment.


The observed differences in TSF susceptibility across eating disorder subtypes suggests that subtypes may be differentially prone to over-evaluation of thoughts about food, which represents a facet of one of the core maintenance mechanisms in cognitive-behavioral models of eating disorders. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:302–309)