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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%. This is a cognitive behavioural model of bulimia nervosa, and forms part of the transdiagnostic model of eating disorders.

Fairburn, Marcus & Wilson (1993) proposed that a dysfunctional system for evaluating self-worth is primary to the maintenance of bulimia nervosa. Instead of evaluating one’s self-worth based on a broad range of criteria they argue that people with bulimia judge themselves “largely, or even exclusively, in terms of their eating habits, shape, or weight (and often all three) and their ability to control them.” The ‘problems’ of bulimia nervosa, such as weight-control behaviour and preoccupation with weight, are seen as resulting from this primary mechanism.

In the extended 2003 theory a number of additional maintenance mechanisms were added to the model. It was proposed that these only operate in some patients, and 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

Fairburn, Cooper & Shafran (2003) proposed a transdiagnostic model of eating disorder, of which this model of bulimia forms a part. One interesting characteristic of the treatment 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”.

This is a Psychology Tools information handout. Suggested uses include:

  • 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
  • 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.
  • Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993b). Cognitive-behavioral therapy for binge eating and bulimia nervosa: a comprehensive treatment manual. In C. G. Fairburn, & G. T. Wilson (Eds.), Binge eating: nature, assessment and treatment (pp. 361–404). New York: Guilford Press.

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