Cognitive Dissonance and Anorexia Nervosa: The Basics

"I prefer to rely on my memory. I have lived with that memory a long time, I am used to it, and if I have rearranged or distorted anything, surely that was done for my own benefit." (Leon Festinger, 1987)

Dissonance 101

There are few things as uncomfortable as feeling you're living in a way that is incompatible with what you believe or value. We have all kinds of labels for this, from "hypocrisy" to "living a lie" (at the more judgemental end of the spectrum) and from "internal conflict" to “leading a double life” (if we're being easier on ourselves—or someone else).

“Cognitive dissonance has been one of the most enduring and successful theories in the history of social psychology” (Cooper, 2019). In his 1957 book, A Theory of Cognitive Dissonance, and in many later publications, Leon Festinger proposed that inconsistency (or dissonance) causes discomfort and that the discomfort motivates us to try to reduce the dissonance. The dissonance can exist either amongst incompatible cognitions (e.g. I think sexism is abhorrent but I really fancy this guy who is clearly sexist) or amongst incompatible behaviours (e.g. I take illegal drugs yet I tell my children not to take illegal drugs) or between incompatible cognitions and behaviours (e. g. I think climate change is the most serious problem facing humanity and I drive my car when I could take public transport). There are, correspondingly, several basic options for reducing the dissonance, all of which involve changing your mind, changing your behaviour, or both.

In the decades since the concept was coined, a large amount of research has been done to support, contradict, and refine the theory, as well as to create applications in which it’s leveraged to improve health and wellbeing. Some of the findings from this body of research are beautifully counter-intuitive unless you're familiar with the theory. For example, if you reduce dissonance by taking a sedative, subsequent attitude change is reduced, while increasing the unpleasant state of dissonance using a mild stimulant increases attitude change. The more effort you make to try to achieve a goal, the more you come to value the goal (because otherwise you’re subjected to the dissonance of trying hard to do something you don't much care about). If you’re paid to do something that induces dissonance, e.g. lie to someone about a brilliant experience you just had, you’ll be less inclined to reduce dissonance by changing your opinion (coming to think more positively about what was actually a rubbish experience) than if you aren’t paid, because you feel more justified in telling the lie when offered a reward to do so.

The same basic mechanism can operate in a socially distributed way too: for instance, listening to someone advocating a behaviour and admitting to having sometimes done the opposite increases attitude change readiness to change behaviour through the discomfort of "vicarious hypocrisy" (feeling implicated in the other person’s belief/behaviour discord).

Factors affecting dissonance reduction

These findings point us towards one of the most important uses for the theory, which is its power to predict what type of dissonance reduction strategy an individual is most likely to employ in a given context, and how intensively they are likely to use it. This in turn makes it possible to modify the relative probabilities of different (more or less desirable) reduction methods by manipulating one or more of the contributing factors, for example, to support therapeutic goals.

When it comes to what, if any, strategies are likely to be employed, some of the major contributing factors uncovered by existing research are as follows (for an overview, see McGrath, 2017):

• Strength of dissonance (the higher it is, the more incentive I have to reduce it).
• Perceived personal responsibility for the dissonance (if I believe I'm not responsible, I won't experience dissonance).
• Social context (the stronger my group identification, the stronger my incentive to vicariously reduce dissonance created by an ingroup member; while more generally, a social setting may function as a dissonance reduction medium, by normalizing habits that might elsewhere be starkly dissonant).
• Effort (a more effortful reduction strategy becomes more attractive to me the higher the dissonance; and if I’m voluntarily doing something effortful or painful, the perceived value of my goal will increase to justify the effort/pain).
• Emotional state (e.g. frustration, anger, and guilt are likely to result in more dissonance reduction effort than sadness and hopelessness).
• Availability of any given reduction method (e.g. is this behaviour practically viable in this context?).
• The perceived probability of success (in basic terms, if a strategy clearly has a low chance of success — e.g. successfully pretending I couldn't help buying the thing on Amazon despite my objections to their business model — I'll probably try something else — e.g. decide to support small businesses in some other way to make up for it).
• Habit (habits exert inertia through automaticity, so a dissonant behaviour is less likely to be changed if it's a deeply embedded habit; and reduction strategies can themselves become habitual, e. g. the standard excuse for procrastination I roll out over and over).
• Cascade effects (if changing one cognition or behaviour is likely to produce new dissonances elsewhere, it’s more likely to be avoided).

Dissonance reduction options

All these factors and more are relevant to what dissonance reduction strategies get enlisted to reduce the unpleasantness of conflict. Expanding on the three broad categories I set out earlier, some of the options we might be selecting from include:

• Changing your mind. The main focus of much of the existing research is on this strategy, which can involve replacing one belief, opinion, or attitude with another, or changing the relative weightings of the cognitions you hold (in terms of quantity or significance). For instance, you could increase the importance of mutually supportive cognitions or reduce the importance of dissonant cognitions (see trivialization below), or you could add more consonant cognitions, e.g. by seeking out new evidence to support your behaviour (this can also include evidence of coercion, as part of a denial of responsibility).
• Denying responsibility. The less responsibility you feel, the less dissonance you feel. So there can be a high incentive to minimize it.
• Trivialization and self-affirmation. Convincing yourself that the dissonance, or any component of it, doesn't matter is a reliable strategy for some dissonances. Affirming a sense of self-integrity, e.g. by making your most important values salient to yourself, also lets you reduce the personal importance of a dissonant behaviour (or thought)—so this strategy works via trivialization too.
• Distraction and forgetting. Diverting your attention away from the dissonant cognition and/or actions is a simple way to (temporarily) reduce dissonance.
• Tolerating rather than reducing. This is particularly common for low levels of dissonance.
• Behaviour change. The trouble with this is that it may require a lot of effort: “Although a major route of dissonance reduction, changing one's behaviour requires effort and is often not the most convenient way to reduce dissonance” (McGrath, 2017, p. 6). It’s therefore often selected after other methods have failed.

Whatever our awareness or otherwise of the selection process going on, these are the kinds of option that tend to be in play when dissonance exists. There are lots of often overlapping possibilities, and changing our behaviour may be amongst the least appealing.

The link to anorexia may be starting to feel pertinent here: Getting to the point of being willing to actually change your eating can take years, not least because there are so many other lower-cost options that do the trick for a while, by making you feel less at war with yourself. But to extend the warfare metaphor: that greater sense of ease in the status quo might come more from capitulation or an uneasy ceasefire than from victory or peace.

In part 2 of this series, I review the existing evidence for the relevance of cognitive dissonance to eating disorders, and then in parts 3 and 4, I’ll suggest some ways in which we might bring the concept into dialogue with the idea of optimization, to understand anorexia better and make a successful recovery more likely.