Eating Disorders

A Guide To Emotions (Psychology Tools For Living Well)
Books & Chapters
All-Or-Nothing Thinking
Information handouts
Am I Experiencing Anorexia?
Exercises
Am I Experiencing Bulimia?
Exercises
Avoidance Hierarchy (Archived)
Archived
Behavioral Experiment
Worksheets
Behavioral Experiment (Portrait Format)
Worksheets
Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)
Information handouts
Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)
Information handouts
Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)
Information handouts
Cognitive Behavioral Model of Perfectionism (Shafran, Egan, Wade, 2010)
Information handouts
Demanding Standards – Living Well With Your Personal Rules
Guides
Discounting In Perfectionism – The Ratchet Effect
Information handouts
Eating And Your Energy Levels
Information handouts
Embracing Uncertainty
Exercises
Evaluating Your Demanding Standards
Worksheets
Exploring Your Demanding Standards
Worksheets
Identifying Your Demanding Standards
Worksheets
Intolerance Of Uncertainty
Information handouts
Intrusive Memory Record
Worksheets
Mental Filter
Information handouts
Overcoming Eating Disorders: Therapist Guide
Treatments That Work®
Overcoming Your Eating Disorder: Workbook
Treatments That Work®
Overgeneralization
Information handouts
Permissive Thinking
Information handouts
Permissive Thinking – Self-Monitoring Record
Worksheets
Personalizing
Information handouts
Recognizing Anorexia Nervosa
Information handouts
Recognizing Bulimia Nervosa
Information handouts
Social Comparison
Information handouts
Starvation Syndrome – The Effects of Semi-Starvation
Information handouts
Therapy Blueprint (Universal)
Worksheets
Thought-Action Fusion
Information handouts
Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 2003)
Information handouts
Uncertainty Beliefs – Experiment Record
Worksheets
Understanding Anorexia
Guides
Understanding Bulimia
Guides
Unhelpful Thinking Styles
Information handouts
What Is Anorexia?
Information handouts
What Is Bulimia?
Information handouts
What Is Compassion Focused Therapy (CFT)?
Information handouts
What Keeps Anorexia Going?
Information handouts
What Keeps Bulimia Going?
Information handouts
Window Of Tolerance
Information handouts
Assessment
- Assessment Of Eating Disorders: Review And Recommendations For Clinical Use | Anderson, Lundgren, Shapiro, Paulosky | 2004
- Journal article download archived copy
- Eating Attitudes Test 26 (EAT-26) | Garner, Olmsted, Bohr, Garfinkel | 1982
- Test (PDF) download archived copy
- Test (Word) download archived copy
- Scoring and interpretation download archived copy
- Website link
- Garner et al. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878
- Eating Disorder Examination (EDE) | Fairburn, Cooper, O’Connor | 2014
- Eating Disorder Examination (Interview | Edition 17.0D) download archived copy
- Eating Disorder Examination Questionnaire (EDE-Q) download archived copy
- Eating Disorder Examination Questionnaire for Adolescents (EDE-A) download archived copy
- Fairburn, C. G., Cooper, Z., & O’Connor, M. (1993). The eating disorder examination. International Journal of Eating Disorders, 6, 1-8.
- ED15 | Tatham, Turner, Mountford, Tritt, Dyas, Waller | 2015
- Scale download archived copy
- Tatham, M., Turner, H., Mountford, V. A., Tritt, A., Dyas, R., & Waller, G. (2015). Development, psychometric properties and preliminary clinical validation of a brief, session‐by‐session measure of eating disorder cognitions and behaviors: The ED‐15. International Journal of Eating Disorders, 48(7), 1005-1015.
Intervention
Treatment guidelines
- Maudsley Service Manual For Child And Adolescent Eating Disorders | Eisler, Simic, Blessitt, Dodge | 2016 download archived copy
- Eating disorders: recognition and treatment | National Institute for Health and Care Excellence (NICE) | May 2017 download archived copy
CBT treatment manuals
- Group cognitive remediation therapy for adolescents with anorexia nervosa: The flexible thinking group | Maiden, Baker, Espie, Simic, Tchanturia | 2014 download archived copy
- Self-help manual for bulimia nervosa | Freeman, Downey | 2001 download archived copy
- Taming the hungry bear: self help for binge eating disorders | Williams
downloadarchived copy - The CBT-T group at the University of Sheffield have developed a version of CBT for Eating Disorders (CBT-ED) that is ten sessions long (CBT-T) and have made a selection of resources available from their manual:
- CBT-T protocol download archived copy
- Basic food diary download archived copy
- Information sheet for patients, their families, and their friends download archived copy
- REAL food guide download archived copy
- Emotions and beliefs that can trigger eating behaviors download archived copy
- Extended food diary, assessing triggers and behaviors download archived copy
- Template for therapy blueprint download archived copy
Other resources
The Centre for Research on Eating Disorders (Credo) have made some useful materials available:
- Transdiagnostic CBT-E formulation download archived copy
- Instructions for self monitoring download archived copy
- Blank monitoring record download archived copy
- Topics to cover when educating patients about eating disorders download archived copy
- Patient handout on regular eating download archived copy
- Binge analysis download archived copy
- Short-term maintenance plan download archived copy
- Long-term maintenance plan download archived copy
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
- Anorexia nervosa download archived copy
- Binge eating disorder ndownload archived copy
- Bulimia nervosa download archived copy
- Compulsive exercise download archived copy
- Helpful tips after residential treatment download archived copy
Disordered eating
- A guide to self-monitoring download archived copy
- All about iron download archived copy
- Body checking and avoidance download archived copy
- Body image and body dissatisfaction download archived copy
- Calcium and bone health download archived copy
- Carbohydrates – myths and facts download archived copy
- Clean eating download archived copy
- Counting calories download archived copy
- Eating disorders and neurobiology download archived copy
- Eating disorders and hormones download archived copy
- Eating disorders and pregnancy download archived copy
- Eating disorders in men download archived copy
- Eating disorders information for carers download archived copy
- Eating disorders: what are the risks? download archived copy
- Evaluating dietary advice download archived copy
- Family based therapy: information for carers, consumers, and professionals download archived copy
- Gastrointestinal changes download archived copy
- Laxative misuse download archived copy
- Making sense of serving sizes download archived copy
- Media and body image download archived copy
- Metabolism and energy requirements download archived copy
- Normal eating vs. disordered eating download archived copy
- Regular eating for recovery download archived copy
- Set point theory download archived copy
- The facts on fat download archived copy
- The REAL food pyramid download archived copy
- Unhealthy exercise download archived copy
- Unhelpful thinking styles download archived copy
- Vegetarian diet and eating disorders download archived copy
- Vomiting and your health download archived copy
- Weekly weighing download archived copy
- What are eating disorders? download archived copy
- Starvation syndrome download archived copy
- Why diets do not work download archived copy
- Dietary guidelines during recovery download archived copy
- Orientation to treatment download archived copy
Worksheets
- Change process balance sheet download archived copy
- Tackling avoided foods download archived copy
- Self-monitoring form download archived copy
Self-Help Programmes
Break Free From ED
- What are eating disorders? download archived copy
- What keeps eating disorder going? download archived copy
- Understanding the number on the scale download archived copy
- Self-monitoring download archived copy
- Food and energy download archived copy
- Eating for recovery – part 1 download archived copy
- Eating for recovery – part 2 download archived copy
- Bing eating download archived copy
- Purging download archived copy
- Driven exercise download archived copy
- Body image 1 – body checking download archived copy
- Body image 2 – body avoidance download archived copy
- Core beliefs download archived copy
- Maintaining your gains and dealing with setbacks download archived copy
- Appendix: getting educated about eating disorders download archived copy
Overcoming disordered eating – part A
- What is an eating disorder? download archived copy
- How ready am I to change? download archived copy
- How eating disorders are maintained download archived copy
- Self-monitoring download archived copy
- Regular eating and weighing download archived copy
- Binge eating, purging and driven exercise download archived copy
- Moods and disordered eating download archived copy
- Dietary rules download archived copy
- Progress review and barriers to change download archived copy
Overcoming disordered eating – part B
- Overevaluation of weight and shape download archived copy
- Challenging unhelpful thinking download archived copy
- Challenging dietary rules download archived copy
- Body checking / avoidance and “feeling fat” download archived copy
- Low self-esteem download archived copy
- Improving low self-esteem download archived copy
- What are mindsets? download archived copy
- Changing mindsets download archived copy
- Relapse prevention download archived copy
Presentations
- Evidence-based cognitive behavioural therapy for eating disorders: principles and practice | Glenn Waller | 2017 download archived copy
- Putting the ‘B’ back into CBT for eating disorders | Glen Waller | 2011
downloadarchived copy - Transdiagnostic CBT for eating disorders “CBT-E” | Chris Fairburn | 2016
downloadarchived copy
Recommended Reading
- Cooper, Z., Fairburn, C. (2009). Management of bulimia nervosa and other binge-eating problems. Advances in Psychiatric Treatment, 15, 129-136 download
- Cooper, Z., & Fairburn, C. G. (2011). The evolution of “enhanced” cognitive behavior therapy for eating disorders: Learning from treatment nonresponse. Cognitive and behavioral practice, 18(3), 394-402 download
- Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics of North America, 33(3), 611-627 download
- Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: Understanding the overlap. Clinical psychology review, 28(3), 366-386.
downloadarchived copy - Wade, T. D., Shafran, R., Cooper, Z. (2023). Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders. International Journal of Eating Disorders download
- Waller, G. (2016). Recent advances in psychological therapies for eating disorders. F1000Research, 5. download
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.