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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
Eating Disorders
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A Guide To Emotions (Psychology Tools For Living Well)

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

Books & Chapters

All-Or-Nothing Thinking

All-Or-Nothing Thinking

All-or-nothing thinking (often also referred to as ‘black and white thinking’, ‘dichotomous thinking’, ‘absolutist thinking’, or ‘binary ... https://www.psychologytools.com/resource/all-or-nothing-thinking

Information handouts

Am I Experiencing Anorexia?

Am I Experiencing Anorexia?

Anorexia (anorexia nervosa) is a condition characterized by the restriction of energy (food) intake relative to requirements, leading to a significant ... https://www.psychologytools.com/resource/am-i-experiencing-anorexia

Exercises

Am I Experiencing Bulimia?

Am I Experiencing Bulimia?

Bulimia (bulimia nervosa) is a condition characterized by recurrent episodes of binge eating, accompanied by repeated inappropriate compensatory behav ... https://www.psychologytools.com/resource/am-i-experiencing-bulimia

Exercises

Avoidance Hierarchy (Archived)

Avoidance Hierarchy (Archived)

NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are ava ... https://www.psychologytools.com/resource/avoidance-hierarchy

Archived

Behavioral Experiment

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

Worksheets

Behavioral Experiment (Portrait Format)

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

Worksheets

Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 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-fairburn-cooper-shafran-2003

Information handouts

Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 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-fairburn-cooper-shafran-2003

Information handouts

Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)

Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 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-hebert-dugas-2019

Information handouts

Cognitive Behavioral Model of Perfectionism (Shafran, Egan, Wade, 2010)

Cognitive Behavioral Model of Perfectionism (Shafran, Egan, Wade, 2010)

People with perfectionism pursue high standards in one or more areas of their life, and base their self-worth on their ability to achieve these standa ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-perfectionism-shafran-egan-wade-2010

Information handouts

Demanding Standards – Living Well With Your Personal Rules

Demanding Standards – Living Well With Your Personal Rules

Demanding Standards – Living Well With Your Personal Rules is a guide written for clients who have high or perfectionistic standards which cause th ... https://www.psychologytools.com/resource/demanding-standards-living-well-with-your-personal-rules

Guides

Discounting In Perfectionism – The Ratchet Effect

Discounting In Perfectionism – The Ratchet Effect

When individuals with perfectionism successfully meet their demanding standards, these accomplishments are often discounted as “easy to do,” “no ... https://www.psychologytools.com/resource/discounting-in-perfectionism-the-ratchet-effect

Information handouts

Eating And Your Energy Levels

Eating And Your Energy Levels

The Eating and Your Energy Levels handout provides an overview of the relationship between food intake and energy levels. It graphically illustrates h ... https://www.psychologytools.com/resource/eating-and-your-energy-levels

Information handouts

Embracing Uncertainty

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

Exercises

Evaluating Your Demanding Standards

Evaluating Your Demanding Standards

Striving to meet demanding standards can be a rewarding process and lead to significant gains. However, demanding standards can also have adverse cons ... https://www.psychologytools.com/resource/evaluating-your-demanding-standards

Worksheets

Exploring Your Demanding Standards

Exploring Your Demanding Standards

The Exploring Your Demanding Standards worksheet is designed to help clients examine a demanding standard, including its advantages and disadvantages. ... https://www.psychologytools.com/resource/exploring-your-demanding-standards

Worksheets

Identifying Your Demanding Standards

Identifying Your Demanding Standards

Striving to meet demanding standards can be a rewarding process and lead to significant gains (e.g., praise, social status, financial rewards, etc.). ... https://www.psychologytools.com/resource/identifying-your-demanding-standards

Worksheets

Intolerance Of Uncertainty

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 handouts

Intrusive Memory Record

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

Worksheets

Mental Filter

Mental Filter

The Mental Filter information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/mental-filter

Information handouts

Overcoming Eating Disorders: Therapist Guide

Overcoming Eating Disorders: Therapist Guide

Overcoming Eating Disorders comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the Client Workbook.&nbs ... https://www.psychologytools.com/resource/overcoming-eating-disorders-therapist-guide

Treatments That Work®

Overcoming Your Eating Disorder: Workbook

Overcoming Your Eating Disorder: Workbook

Overcoming Eating Disorders comes in two volumes. This page is for the Client Workbook. Click on the following link to access the accompanying Therapi ... https://www.psychologytools.com/resource/overcoming-your-eating-disorder-workbook

Treatments That Work®

Overgeneralization

Overgeneralization

The Overgeneralization information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effect ... https://www.psychologytools.com/resource/overgeneralization

Information handouts

Permissive Thinking

Permissive Thinking

The Permissive Thinking information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/permissive-thinking

Information handouts

Permissive Thinking – Self-Monitoring Record

Permissive Thinking – Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/permissive-thinking-self-monitoring-record

Worksheets

Personalizing

Personalizing

The Personalizing information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/personalizing

Information handouts

Recognizing Anorexia Nervosa

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 handouts

Recognizing Bulimia Nervosa

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 handouts

Social Comparison

Social Comparison

The Social Comparison information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effecti ... https://www.psychologytools.com/resource/social-comparison

Information handouts

Starvation Syndrome – The Effects of Semi-Starvation

Starvation Syndrome – The Effects of Semi-Starvation

The Starvation Syndrome – Effects of Semi-Starvation handout provides an overview of the Minnesota Starvation Experiment and common symptoms of semi ... https://www.psychologytools.com/resource/starvation-syndrome-the-effects-of-semi-starvation

Information handouts

Therapy Blueprint (Universal)

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal

Worksheets

Thought-Action Fusion

Thought-Action Fusion

The Thought-Action Fusion information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/thought-action-fusion

Information handouts

Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 2003)

Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 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-fairburn-cooper-shafran-2003

Information handouts

Uncertainty Beliefs – Experiment Record

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record

Worksheets

Understanding Anorexia

Understanding Anorexia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-anorexia

Guides

Understanding Bulimia

Understanding Bulimia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-bulimia

Guides

Unhelpful Thinking Styles

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. In the 1960s, Aaron Beck identified several of these biases which were common in his d ... https://www.psychologytools.com/resource/unhelpful-thinking-styles

Information handouts

What Is Anorexia?

What Is Anorexia?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-anorexia

Information handouts

What Is Bulimia?

What Is Bulimia?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-bulimia

Information handouts

What Is Compassion Focused Therapy (CFT)?

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 handouts

What Keeps Anorexia Going?

What Keeps Anorexia Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-anorexia-going

Information handouts

What Keeps Bulimia Going?

What Keeps Bulimia Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-bulimia-going

Information handouts

Window Of Tolerance

Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

Information handouts

Assessment

  • Assessment Of Eating Disorders: Review And Recommendations For Clinical Use | Anderson, Lundgren, Shapiro, Paulosky | 2004
  • Eating Attitudes Test 26 (EAT-26) | Garner, Olmsted, Bohr, Garfinkel | 1982
  • 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 download archived 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:

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

Break Free From ED

Overcoming disordered eating – part A

Overcoming disordered eating – part B

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 download archived copy
  • Transdiagnostic CBT for eating disorders “CBT-E” | Chris Fairburn | 2016 download archived 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. download archived 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.

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