Fading Obesity to Grey

“Black-and-white” thinking (also often referred to as “all-or-nothing”), is a cognitive style that is not uncommon in dieters, overweight, and eating disordered patients. This form of dichotomous thinking is seen as a form of cognitive rigidity, whereby individuals see things as “either-or” rather than a continuum (shades of grey).

This kind of thinking is typical in children, who tend to use words like “never”, “always”, “love”, “hate”, with no shades in between. Under emotional stress, adults tend to also fall into this kind of thinking, where everything is either going great and absolutely fantastic or nothing seems to be working at all. Dichotomous thinking has been shown to exacerbate depression, marital conflict, anxiety, and a host of other everyday problems.

In the context of obesity, dichotomous thinking style may contribute to weight problems – by promoting the use of rigid dietary “rules”, and by precipitating binge eating following any transgression from these rules. It is therefore not surprising that dichotomous thinking has been reported as one of the most important predictors of weight regain in women undergoing weight loss (Susan Byrne et al., 2004).

The Dichotomous Thinking in Eating Disorders Scale (DTEDS) is a short, self-report measure of a dichotomous cognitive style primarily intended for use with dieters, overweight/obese patients and eating disordered patients.

The 11 questionnaire items that load on two subscales, which assess Eating-specific and General aspects of dichotomous thinking, are the following:

1. I think of food as either “good” or “bad”
2. I think of things in “black and white” terms
3. I think of myself as either good or bad
4. I view my attempts to diet as either successes or failures
5. I think of myself as either in control or out of control
6. When dieting, if I eat something that I had planned not to, I think that I have failed
7. I think of myself as either clever or stupid
8. When dieting, I view my eating as having been either good or bad
9. I either get on very well with people or not at all
10. I think of myself as either ugly or good-looking
11. I think of myself as doing things either very well or very badly

Each item is scored on a range of not at all, slightly, fairly, or very true of me.

Identifying and addressing dichotomous thinking is an essential part of the psychological work up and treatment of bariatric patients, especially in those with binge-eating disorder and patients with a strong history of weight cycling.

Comments on the importance of “black-and-white” thinking are welcome.

Edmonton, Alberta