Eating disorders and sense of self: A learning theory conceptualization Ashley M. Wood a , Judith A. Dygdon a, ⁎, Anthony J. Conger b a Roosevelt University, USA b Purdue University, USA abstract article info Article history: Received 11 April 2014 Received in revised form 21 October 2014 Accepted 3 December 2014 Available online 10 December 2014 Keywords: Eating disorders Interoceptive awareness Sense of self Bulimia nervosa Learning Verbal learning The learning theory view of sense of self is that problems in one's knowledge about the self arise when: (1) care- givers fail to recognize indicators of a child's private emotional and visceral experiences and (2) subsequently fail to offer appropriate labels that discriminate among those experiences. The purpose of this study was to evaluate the relationship of the process believed to build a sense of self to level of interoceptive awareness (IA) and to risk for eating disorders. One hundred twenty seven undergraduate and graduate students (112 women) completed the Eating Disorders Inventory—3 (EDI-3). Authors assigned (EDI-3) subscales to one of two groups based on their relevance to IA (i.e., IA-relevant and Not IA-relevant.) The classification was supported by factor analysis. Subscales from the EDI-3 were thus used as a measure of a respondent's IA level. Students also completed the Experience of Self Scale (EOSS). The EOSS was used as a measure of a respondent's likely exposure to the expe- riential process believed to build sense of self. Product-moment correlations and multiple regression modeling were used to test the relationships between EOSS and EDI-3 IA-relevant, Not IA-relevant, and Eating Disorder risk scores. With few exceptions, results suggested that IA level and sense of self process are related. These find- ings warrant further exploration of the relationship between IA level and sense of self process. A link between the two would inform our understanding of how problems in IA develop and how best to prevent and treat them. © 2014 Elsevier Ltd. All rights reserved. Research suggests a relationship between interoceptive awareness (IA), or awareness of visceral/emotional events, and eating disorders (EDs) (e.g., Craighead, 2006; Fassino, Pierò, Cramaglia, & Abbate-Daga, 2004; Garner, Olmstead, & Polivy, 1983; Leon, Fulkerson, Perry, & Cudeck, 1993; Leon, Fulkerson, Perry, & Early-Zald, 1995). Misidentifica- tion of internal events leads to inappropriate responses to ameliorate them. When confronted with aversive states (e.g., loneliness, hunger) human beings routinely apply escape/avoidance responses (see Catania, 2013) to terminate or lessen them. The resulting reduction of aversiveness negatively reinforces the response, leading to its recur- rence. The individual who accurately identifies aversive internal states finds responses that remedy them (e.g., “When I am hungry, I eat.” “When I am lonely, I look for a conversation partner.”). However, the in- dividual who misidentifies aversive internal states may not discriminate among them (e.g., “hungry” from “lonely”; simply identifying both as “bad”) and misapply escape/avoidance responses. For some, bingeing may be a misapplied escape/avoidance response. Having binged often elicits its own set of bad feelings, evoking purging as a second escape/ avoidance response. This explanation is consistent with learning theory and with opinions in the ED literature (e.g., Heatherton & Baumeister, 1991). Relatedly, individuals who misidentify aversive internal states are inefficient in deciding when to end a behavior that was applied to remedy them. Some argue (e.g., Shafran & de Silva, 2003) that clarifying factors associated with EDs, like IA problems, should lead to improved prevention/intervention. Bruch (1969) posited that identi fication and labeling of internal states is not innate but learned ability. An understanding of how IA is learned should enhance our knowledge about preventing/ameliorating IA problems. The learning theory literature on sense of self (Kanter, Parker, & Kohlenberg, 2001; Kohlenberg & Tsai, 1991, 1995) provides a model for how life experiences build IA. The expression of internal events in the young is undifferentiated. Adverse emotion is communicated with crying; appetitive, with cooing and smiling. Parents/caregivers help make the child's response more specific. When done properly, care- givers look to external events surrounding the undifferentiated response (e.g., crying) and offer labels that match the likely internal event. Kanter et al. (2001) offer “you're hungry” as an example of a matching caregiver response in the case in which it had been a long time since feeding; “you're hurt” would be a matching caregiver re- sponse if the child had just fallen. Over time, careful caregivers' guesses are more correct than incorrect. The child learns labels that match internal states and uses these labels to communicate with others about him/herself and guide his/her search for solutions to distress. However, when caregivers fail to look carefully for external clues, responding inappropriately (e.g., “you're hungry” even though the child has just fallen; “you can't be hungry” even though the last meal was long ago), two problematic things happen: The child fails to develop labels for internal events and becomes dependent on others Eating Behaviors 17 (2015) 45–48 ⁎ Corresponding author at: Roosevelt University, 430 South Michigan Avenue, GB 314A, Chicago, IL 60605, USA. Tel.: +1 312 341 3751. E-mail address: jdygdon@roosevelt.edu (J.A. Dygdon). http://dx.doi.org/10.1016/j.eatbeh.2014.12.001 1471-0153/© 2014 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Eating Behaviors