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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 concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Anorexia Going? is designed to help clients experiencing anorexia understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

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A PDF of the resource plus client-friendly instructions where appropriate.

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An editable Microsoft PowerPoint version of the resource.

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Languages this resource is available in

  • Chinese (Simplified)
  • English (GB)
  • English (US)
  • Italian
  • Polish
  • Slovenian
  • Spanish (International)

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Introduction & Theoretical Background

It is common for people to feel conscious of their eating, but extreme dieting and weight loss can lead to an eating disorder called anorexia (or anorexia nervosa), which may impact their physical and mental health. Symptoms of anorexia include:

  • Eating less and less.
  • Losing weight.
  • Having strict rules about eating (e.g., what you are allowed to eat, when, and where).
  • Thinking often about your weight and body shape.
  • Feeling fat when others think you are too thin.
  • Sometimes losing control over your food intake (binge-eating).
  • Feeling low, irritable, and not wanting to be around others.
  • Trying to prevent weight gain in other ways (e.g., vomiting or taking laxatives).
  • Exercising excessively or compulsively.

Research has demonstrated that Cognitive Behavioral Therapy (CBT) is a helpful psychological therapy for anorexia. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle.

The What Keeps Anorexia Going? information handout describes some of the key factors which act to maintain anorexia, and it illustrates them in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about these processes is an essential part of cognitive therapy for anorexia. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

Therapist Guidance

One interesting way of thinking about anorexia is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people keep experiencing symptoms of anorexia. I wonder if we could look at it together and think about whether it describes some of what is happening for you?

References And Further Reading

  • Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
  • 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.
  • Galsworthy-Francis, L., & Allan, S. (2014). Cognitive behavioural therapy for anorexia nervosa: A systematic review. Clinical Psychology Review, 34, 54-72.
  • Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current Opinion in Psychiatry, 29, 340-345.
  • National Institute for Health and Care Excellence (NICE: 2017). Eating disorders: Recognitions and treatment. Retrieved from:
  • Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive behavioral therapy for eating disorders: A comprehensive treatment guide. Cambridge University Press.