Self-Deception and the Second Factor: How Desire Causes Delusion in Anorexia Nervosa

Empiricist models explain delusional beliefs by identifying the abnormal experiences which ground them. Recently, this strategy has been adopted to explain the false body size beliefs of anorexia nervosa patients. As such, a number of abnormal experiences of body size which patients suffer from have been identified. These oversized experiences convey false information regarding the patients’ own bodies, indicating that they are larger than reality. However, in addition to these oversized experiences, patients are also exposed to significant evidence suggesting their bodies are in fact thin. This situation poses a conundrum: why do patients appear strongly influenced by the former kinds of evidence while the latter has little effect? To solve this conundrum, I suggest a two-factor account. First, I discuss research on the biases patients exhibit in how they gather, attend to and interpret evidence related to their own body size. Such biases in evidence treatment, I suggest, cause oversized experiences to be sought out, attended to and accepted, while veridical body size experiences are ignored or explained away. These biases constitute the second factor for this empiricist model, accounting for the unwarranted conviction with which these beliefs are held. Finally, in line with recent research into self-deception, I propose that, paradoxically, these biases in evidence treatment arise from patients’ own desires.