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

Anorexia nervosa is characterized by:

• A restriction of energy intake relative to requirements leading to significantly low body weight
• Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
• Disturbances in the way body shape and weight is experienced, and/or undue influence of body weight or shape on self-evaluation

(American Psychiatric Association, 2013). Fairburn, Cooper & Shafran (2003) argue that over-evaluation of eating, shape and weight, and their control is central to the maintenance of anorexia nervosa. They propose that this cognitive process drives dieting and weight control behavior which results in ‘starvation syndrome’ and further cognitive changes. Their model of anorexia nervosa presented here describes the maintenance of both a ‘restricting type’ and a ‘binge-eating / purging type’. In their extended transdiagnostic theory of eating disorders (of which the present maintaining processes form a part) the authors identify a number of additional maintenance mechanisms which operate in some cases of anorexia nervosa. These include:

• Clinical perfectionism
• Core low self-esteem (persistent and pervasive negative self-beliefs that are viewed as part of the individual’s self-identity)
• Mood intolerance (difficulty coping with strong mood states)
• Interpersonal difficulties

One interesting characteristic of the full transdiagnostic model is that “The patient’s specific eating disorder diagnosis is not of relevance to the treatment. Rather, its content is dictated by the particular psychological features present and the processes that appear to be maintaining them”.

• Client handout – use as a psychoeducation resource
• Discussion point – use to provoke a discussion and explore client beliefs
• Therapist learning tool – improve your familiarity with a psychological construct
• Teaching resource – use as a learning tool during training

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Arlington, VA: American Psychiatric Publishing.
• Fairburn, C. G., Cooper, Z., Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509-528.
• Smink, F. R., Van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406-414.