Influence of Cognitive Biases in Visual Evaluation of Food Amount in Patients Affected by Eating Disorders

  • Piergiuseppe Vinai


We analyzed the influence of perceptive, cognitive, and emotional factors in the evaluation of food amounts among patients affected by Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. No perceptive bias has been found, but cognitive and emotional biases seem to influence their evaluations. Anorexic subjects share the tendency to underestimate the number of presented items with the general population. Moreover, they tend to exaggerate the size of food, perceiving it as bigger than the control subjects do. Bulimic patients base their perception of binging on the type of food consumed, rather than basing it on the amount. Consumption of even small amounts of forbidden food may lead them to perceive their meal as a binge. Patients affected by Binge Eating Disorder report that their typical and largest-ever portions of foods are larger in a very significant way compared with those of the control subjects. Biases in evaluation of food amounts are also present in the general population and among obese subjects not affected by any eating disorders and can contribute towards gaining weight. To deal with this impairment several tools have been developed over the last few years. The last part of the chapter reviews the efficacy of these instruments to improve the subjects’ ability in evaluating the amount of their own food intake.


Anorexia Nervosa Eating Disorder Bulimia Nervosa Binge Eating Disorder Portion Size 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Anorexia nervosa


Adjustable wedge


Binge eating disorder


Body mass index


Bulimia nervosa


Food amount rating scale


Food frequency questionnaire


Food portion photograph book


Interactive portion size assessment system


Portion size measurement aids


  1. Allik J, Tuulmets T. Percept Psychophys. 1991;49(4):303–14.Google Scholar
  2. Ayala GX. Health Educ Res. 2006;21:133–45.PubMedCrossRefGoogle Scholar
  3. Bandini LG, Schoeller DA, Cyr HN, Dietz WH. Am J Clin Nutr. 1990;52:421–5.PubMedGoogle Scholar
  4. Beasley LJ, Hackett AF, Maxwell SM, Stevenson L. J Hum Nutr Diet. 2004;17:219–25.PubMedCrossRefGoogle Scholar
  5. Beasley J, Riley WT, Jean-Mary J. Nutrition. 2005;21:672–7.PubMedCrossRefGoogle Scholar
  6. Blake AJ, Guthrie HA, Smiciklas-Wright H. J Am Diet Assoc. 1989;89:962–4.PubMedGoogle Scholar
  7. Blundell JE. Am J Clin Nutr. 2000;71:3–5.PubMedGoogle Scholar
  8. Briefel RR, Johnson CL. Annu Rev Nutr. 2004;24:401–31.PubMedCrossRefGoogle Scholar
  9. Brunstrom JM, Rogers PJ, Pothos EM, Calitri R, Tapper K. Appetite. 2008;51:296–301.PubMedCrossRefGoogle Scholar
  10. Burger KS, Kern M, Coleman KJ. J Am Diet Assoc. 2007;107:611–8.PubMedCrossRefGoogle Scholar
  11. Cypei YS, Guenthet PM, Petot GJ. J Am Diet Assoc. 1997;97:289–92.CrossRefGoogle Scholar
  12. Davis C, Levitan RD, Muglia P, Bewell C, Kennedy JL. Obes Res. 2004;12:929–35.PubMedCrossRefGoogle Scholar
  13. Davis C, Curtis C, Tweed S, Patte K. Eat Behav. 2007;8:170–6.PubMedCrossRefGoogle Scholar
  14. Dohm FA, Cachelin FM, Striegel-Moore RH. Obes Res. 2005;13:1061–9.PubMedCrossRefGoogle Scholar
  15. Dohm FA, Striegel-Moore RH. Obes Res. 2002;10:1173–9.PubMedCrossRefGoogle Scholar
  16. Epstein J, Wiseman CV, Sunday SR, Klapper F, Alkalay L, Halmi KA.. Eat Weight Disord. 2001;6:140−7.PubMedGoogle Scholar
  17. Foster E, Matthews JN, Nelson M, Harris JM, Mathers JC, Adamson AJ. Public Health Nutr. 2006;9:509–14.PubMedCrossRefGoogle Scholar
  18. Foster E, Mattheews JN, Lloyd J, Marshall L, Mathers JC, Nelson M, Barton KL, Wrieden WL, Cornelissen P, Harris J, Adamson AJ. Br J Nutr. 2008;99:175–84.Foster E, Adamson AJ, Anderson AS, Barton KL, Wrieden WL. Eur J Clin Nutr. 2009;63:45–9.Google Scholar
  19. Frobisher C, Maxwell SM. J Hum Nutr Diet. 2003;16:181–8.PubMedCrossRefGoogle Scholar
  20. Ginsburg N. J Gen Psychol. 1980;103:211–6.PubMedCrossRefGoogle Scholar
  21. Ginsburg N. Am J Psychol. 1978;91:267–73.PubMedCrossRefGoogle Scholar
  22. Ginsburg N, Nicholls A. Percept Mot Skills. 1988;67:656–8.PubMedCrossRefGoogle Scholar
  23. Gleaves DH, Williamson DA, Barker SE. Addict Behav. 1993;18:299-309.PubMedCrossRefGoogle Scholar
  24. Godwin S, Chambers E, Cleveland L, Ingwersen L. J Am Diet Assoc. 2006;106:1246–50.PubMedCrossRefGoogle Scholar
  25. Greeno CG, Wing RR, Marcus MD. Addict Behav. 1999;24:299–303.PubMedCrossRefGoogle Scholar
  26. Guertin TL, Conger AJ. Addict Behav. 1999;24:175–93.PubMedCrossRefGoogle Scholar
  27. Guthrie HA. J Am Diet Assoc. 1984;84:1440–4.PubMedGoogle Scholar
  28. Harnack L, Steffen L, Arnett DK, Gao S, Luepker RV. J Am Diet Assoc. 2004;104:804–6.PubMedCrossRefGoogle Scholar
  29. Herman CP, Polivy J. Res Publ Assoc Res Nerv Ment Dis. 1984;62:141–56.PubMedGoogle Scholar
  30. Howat PM, Mohan R, Champagne C, Monlezun C, Wozniak P, Bray GA. J Am Diet Assoc. 1994;94:169–73.PubMedCrossRefGoogle Scholar
  31. Huybregts L, Roberfroid D, Lachat D, Van Camp J, Kolsteren P. Public Health Nutr. 2008;11:581–7.PubMedCrossRefGoogle Scholar
  32. Kales EF. Physiol Behav. 1990;48:837–40.PubMedCrossRefGoogle Scholar
  33. Kales EF. Appetite. 1991;17:241–2.PubMedCrossRefGoogle Scholar
  34. Keel PK, Mayer SA, Harnden-Fischer JH. Int J Eat Disord. 2001;29:294–301.PubMedCrossRefGoogle Scholar
  35. Kirkcaldy-Hargreaves M, Lynch GW, Santor C. J Can Diet Assoc. 1989;41:102–10.Google Scholar
  36. Klesges RC, Eck LH, Ray JW. J Consult Clin Psychol. 1995;63:438–44.PubMedCrossRefGoogle Scholar
  37. Knight LJ, Boland FJ. J Abnorm Psychol. 1989;98:412–20.PubMedCrossRefGoogle Scholar
  38. Kuehneman T, Stanek K, Eskridge K, Angle C. J Am Diet Assoc. 1994;94(5):548–51.Google Scholar
  39. Lansky D, Brownell KD. Am J Clin Nutr. 1982;35:727–32.PubMedGoogle Scholar
  40. Lillegaard IT, Overby NC, Andersen LF. Eur J Clin Nutr. 2005;59:611–17.PubMedCrossRefGoogle Scholar
  41. Loxton NJ, Dawe S. Int J Eat Disord. 2001;29:455–62.PubMedCrossRefGoogle Scholar
  42. Macdiarmid J, Blundell JE. Nutr Res Rev. 1998;11:231–53.PubMedCrossRefGoogle Scholar
  43. Marilyn AZ. Addictive Behav. 1984;9:347–50.CrossRefGoogle Scholar
  44. Matheson DM, Hanson KA, McDonald TE, Robinson TN. Arch Pediatr Adolesc Med. 2002;156:867–71.PubMedGoogle Scholar
  45. Muhlheim LS, Allison DB, Heshka S, Heymsfield SB. Int J Eat Disord. 1998;24:259–66.PubMedCrossRefGoogle Scholar
  46. Nelson M, Atkinson M, Darbyshire S. Br J Nutr. 1994;72:649–63.PubMedCrossRefGoogle Scholar
  47. Overduin J, Jansen A, Louwerse E. Int J Eat Disord. 1995;18:277−85.PubMedCrossRefGoogle Scholar
  48. Polivy J, Herman CP. Am Psychol. 1985;40:193–201.PubMedCrossRefGoogle Scholar
  49. Posner BM, Smigelski C, Duggal A, Morgan JL, Cobb J, Cupples LA. J Am Diet Assoc. 1992;92:738–41.PubMedGoogle Scholar
  50. Rapp SR, Dubbert PM, Burkett PA, Buttross Y. J Am Diet Assoc. 1986;86:249–51.PubMedGoogle Scholar
  51. Robson Pj, Livingstone MB. Public Health Nutr. 2000;3:183–92.Google Scholar
  52. Rosen JC, Leitenberg H, Gross J, Willmuth M. Adv Behav Res Ther. 1985;7:181–97.CrossRefGoogle Scholar
  53. Scagliusi FB, Polacow VO, Artioli GG, Benatti FB, Lancha AHJ. J Am Diet Assoc. 2003;103:1306–13.PubMedCrossRefGoogle Scholar
  54. Skrzypek S, Wehmeier PM, Remschmidt H. Eur Child Adolesc Psychiatry. 2001;10:215−21.PubMedCrossRefGoogle Scholar
  55. Stanton AL, Tips TA. Int J Eat Disord. 1990;9:387–93.CrossRefGoogle Scholar
  56. Telch CF, Agras WS, Rossiter EM, Wilfley D, Kenardy J. J Consult Clin Psychol. 1990;58:629–35.PubMedCrossRefGoogle Scholar
  57. Turconi G, Guarcello M, Berzolari FG, Carolei A, Bazzano R, Ruggeri C. Eur J Clin Nutr. 2005;59:923–31.PubMedCrossRefGoogle Scholar
  58. Urdapilleta I, Mirabel-Sarron C, Meunier JM, Richard JF. Encephale. 2005;31:82−91.PubMedCrossRefGoogle Scholar
  59. Venter CS, MacIntyre UE, Vorster HH. J Hum Nutr Diet. 2000;13:205–18.PubMedCrossRefGoogle Scholar
  60. Vinai P, Cardetti S, Ferrato N, Vallauri P, Carpegna G, Masante D, Luxardi G, Todisco P, Manara F, Ruggiero GM, Sassaroli S. Eat Behav. 2007;8:291–5.PubMedCrossRefGoogle Scholar
  61. Vinai P, Carpegna G, Cardetti S, Ferrato N, Vallauri P, Masante D, Meister A, Ruggiero GM, Sassaroli S. Eat Disord. 2008;16:128–35.PubMedCrossRefGoogle Scholar
  62. Webb CA, Yuhas JA. J Am Diet Assoc. 1988;88:601–2.PubMedGoogle Scholar
  63. Willett WC. In: Willett WC, editor. Nutritional epidemiology. New York: Oxford University Press; 2002. pp. 74–100.Google Scholar
  64. Yellowlees PM, Roe M, Walker MK, Ben-Tovim DI. Br Med J. 1988;296:1689–90.CrossRefGoogle Scholar
  65. Yuhas JA, Bolland JE, Bolland TW. J Am Diet Assoc. 1989;89:1473–7.PubMedGoogle Scholar
  66. Williamson DA, Gleaves DH, Lawson OJ. J Psychopathol Behav Assess. 1991;13:257–68.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.“GNOSIS” No Profit Research GroupMagliano AlpiItaly

Personalised recommendations