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Eating Disorders

People with eating disorders experience significant alterations in their relationships with food. For example, individuals with anorexia nervosa restrict their food intake and individuals with bulimia nervosa experience episodes of binge eating followed by efforts to avoid gaining weight, including vomiting or excessive exercise. Cognitive behavioral therapy (CBT) and family-based therapy (FBT) are both evidence-based treatments for eating disorders. Read more
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A Guide To Emotions (Psychology Tools For Living Well)

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ... https://www.psychologytools.com/resource/a-guide-to-emotions-psychology-tools-for-living-well/

Chapter

Avoidance Hierarchy

Avoidance and safety-seeking behavior serves to maintain anxiety, and exposure to the fear stimuli/situation is an effective treatment for anxiety. Th ... https://www.psychologytools.com/resource/avoidance-hierarchy/

Exercise

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

Worksheet

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

Worksheet

CBT Thought Record

The CBT Thought Record is an essential tool in cognitive behavioral therapy. Thought challenging records help people to evaluate their negative automa ... https://www.psychologytools.com/resource/cbt-thought-record/

Worksheet

Cognitive Behavioral Model Of Anorexia Nervosa (2003)

Anorexia nervosa is an eating disorder characterized by restriction of energy intake and intense fear of gaining weight. For women, the lifetime preva ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-anorexia-nervosa-2003/

Information Handout

Cognitive Behavioral Model Of Bulimia Nervosa (2003)

Bulimia nervosa is an eating disorder characterized by binge eating followed by purging. Among young women, the point prevalence of bulimia is about 1 ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-bulimia-nervosa-2003/

Information Handout

Cognitive Behavioral Model Of Intolerance Of Uncertainty (2019)

Intolerance of uncertainty (IU) has been defined as “an underlying fear of the unknown”. Intolerance of uncertainty is a risk factor for the deve ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-intolerance-of-uncertainty-2019/

Worksheet

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty/

Exercise

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty/

Information Handout

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record/

Worksheet

Mindful Attention (Audio)

Mindful Attention is a technique for becoming aware of one’s thoughts and experiences, and being able to observe these as transient mental events. ... https://www.psychologytools.com/resource/mindful-attention-audio/

Audio

Motivational Systems (Emotional Regulation Systems)

At the heart of Compassion Focused Therapy (CFT) is an evolutionary model of human motivational systems. Developed by Paul Gilbert it is a helpful len ... https://www.psychologytools.com/resource/motivational-systems-emotional-regulation-systems/

Information Handout

Recognizing Anorexia Nervosa

Anorexia nervosa is characterized the restriction of energy intake, leading to a severely low weight in the context of an individual’s age, sex, and ... https://www.psychologytools.com/resource/recognizing-anorexia-nervosa/

Information Handout

Recognizing Bulimia Nervosa

Bulimia nervosa is characterized by recurrent episodes of binge eating and compensatory behaviors to prevent weight gain. Recognizing Bulimia Nervosa ... https://www.psychologytools.com/resource/recognizing-bulimia-nervosa/

Information Handout

Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ... https://www.psychologytools.com/resource/therapy-blueprint/

Exercise

Thought Challenging Record 7 Column

The thought record is an essential tool in cognitive behavioral therapy (CBT). Thought challenging records help people to evaluate their negative auto ... https://www.psychologytools.com/resource/thought-challenging-record-7-column/

Worksheet

Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (2003)

Fairburn, Cooper & Shafran (2003) argue that eating disorders such as anorexia and bulimia share common maintenance mechanisms despite difference ... https://www.psychologytools.com/resource/transdiagnostic-cognitive-behavioral-model-of-eating-disorders-2003/

Information Handout

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

Information Handout

What Is Compassion Focused Therapy (CFT)?

Compassion focused therapy (CFT) was developed to work with issues of shame and self-criticism. The CFT model complements and expands the traditional ... https://www.psychologytools.com/resource/what-is-compassion-focused-therapy-cft/

Information Handout

Assessment

Intervention

Treatment guidelines

CBT treatment manuals

Other resources

The Centre for Research on Eating Disorders (Credo) have made some useful materials available:

The Institute of Psychiatry used to keep an up-to-date page of resources relevant to eating disorders – now only available via archive.org

Information Handouts

Disordered eating

Worksheets

Self-Help Programmes

Overcoming disordered eating – part A

Overcoming disordered eating – part B

Presentations

Recommended Reading

What Are Eating Disorders?

Signs and Symptoms of Eating Disorders

Common to many of the eating disorders are a preoccupation with weight and body shape, significant anxiety about gaining weight, and behaviors intended to mitigate the anxiety.

Symptoms of anorexia nervosa may include:

  • restriction of energy intake leading to weight that is less than minimally normal or expected in the context of age, sex, developmental trajectory, and physical health;
  • an intense fear of gaining weight, an intrusive dread of fatness, or persistent behavior that interferes with weight gain;
  • disturbed perception of one’s body weight (e.g., a self-perception of being too fat);
  • self-evaluation is unduly influenced by body weight or shape;
  • a persistent lack of insight regarding the seriousness of low body weight;
  • endocrine disorder resulting in amenorrhea or loss of sexual interest or potency.

Symptoms of bulimia nervosa include:

  • recurrent episodes of binge eating (overeating) where excessively large amounts of food are consumed in a discrete period of time;
  • a feeling of lack of self-control over eating during a binge-eating episode;
  • recurrent behaviors to counteract weight gain such as self-induced vomiting, purging, fasting, use of drugs, diuretics, or excessive exercise;
  • self-evaluation is unduly influenced by body weight or shape;
  • a self-perception of being too fat and an intrusive dread of fatness.

Psychological Models and Theory of Eating Disorders

Fairburn, Cooper, and Shafran (2003) proposed a transdiagnostic cognitive behavioral model of eating disorders that describes the maintenance of both anorexia nervosa and bulimia nervosa. Central to the model is the individual’s judgment of their self-worth in terms of body weight or shape. Disordered eating behaviors are understood as a consequence of these self-beliefs.

Evidence-Based Psychological Approaches for Working with Eating Disorders

Enhanced Cognitive Behavior Therapy for Eating Disorder (CBT-E)

In 2003, Fairburn et al. argued for value in viewing eating disorders from a transdiagnostic perspective. They say that common mechanisms, such as a restricted assessment of self-worth, underpinned both anorexia and bulimia. CBT-E includes elements that focus on modification of eating habits, weight-control behavior, and concerns about eating, shape, and weight.

Family-Based Treatment (FBT) / Maudsley Family Therapy

FBT is an outpatient, intensive treatment in which the family is used as the primary resource to renourish the affected child or adolescent. It is described as a highly practical approach that attempts to modify problems in family structure that make refeeding more difficult (Lock and le Grange, 2005). Average length of treatment is 9–12 months. A 2013 meta-analysis indicated that individual therapy and FBT were equivalently effective at the end of treatment, but that FBT was superior at 6–12 month follow-up (Couturier, Kimber, & Szatmari, 2013).

Resources for Working with Eating Disorders

Psychology Tools resources available for working therapeutically with eating disorders may include:

  • psychological models of eating disorders including anorexia and bulimia
  • information handouts for eating disorders including anorexia and bulimia
  • exercises for eating disorders including anorexia and bulimia
  • CBT worksheets for eating disorders including anorexia and bulimia
  • self-help programs for eating disorders including anorexia and bulimia

References

  • Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of family‐based treatment for adolescents with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 46(1), 3–11.
  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviourtherapy for eating disorders: A ‘transdiagnostic’ theory and treatment. BehaviourResearch and Therapy, 41(5), 509–528.
  • Lock, J., & le Grange, D. (2005). Family‐based treatment of eating disorders. International Journal of Eating Disorders, 37(S1), S64–S67.