Reconstructing the internal world of the eating-disordered individual: Overcoming denial and distortion in self-report

Although denial and distortion are widely acknowledged to affect the accuracy of self-report in the eating disorders, little is known about their extent and implications, and there have been few attempts to develop systematic strategies for obtaining more valid data. In anorexia nervosa and bulimia nervosa, internal experience may be misrepresented through the processes of deliberate distortion, inadvertent distortion, or overcompliance. Traditional methods of overcoming or correcting for denial include clinical intuition, reliance on the testimony of treated patients, and direct confrontation. Unfortunately, each of these approaches may compound subjects' biases with clinician—researchers' biases. Alternative methods for reducing denial and distortion in self-report must be developed; these may include separating research and therapy, providing incentives for accurate accounts, obtaining information from other informants, using more appropriate control groups, collecting data in vivo, asking for behavioral commitments, seeking subjects' commentary on their own responses, and making more creative use of nonobvious assessment techniques.