UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Anorexia nervosa in adults: Cognitive-behavioral therapy (CBT)

Author
Kathleen Pike, PhD
Section Editor
Joel Yager, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Cognitive-behavioral therapy (CBT) was developed in the 1970s by Aaron Beck to treat depression and anxiety [1-3]. It has since been modified for treating other mental illnesses, such as eating disorders [4-8]. Treatment of acute, low-weight anorexia nervosa often requires multiple interventions, including psychotherapy such as CBT [9,10]. In addition, CBT can prevent relapse [11,12].

This topic reviews CBT for treating anorexia nervosa. The epidemiology, clinical features, diagnosis, assessment, medical complications, and other treatments are discussed separately:

(See "Eating disorders: Overview of epidemiology, clinical features, and diagnosis".)

(See "Anorexia nervosa in adults: Clinical features, course of illness, assessment, and diagnosis".)

(See "Anorexia nervosa in adults and adolescents: Medical complications and their management".)

                             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Jun 10 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Beck AT. Cognitive Therapy and the Emotional Disorders, International University Press, New York 1976.
  2. Rush AJ, Beck AT. Cognitive therapy of depression and suicide. Am J Psychother 1978; 32:201.
  3. Beck AT. The past and future of cognitive therapy. J Psychother Pract Res 1997; 6:276.
  4. Fairburn GC. Cognitive Behavior Therapy and Eating Disorders, Guilford Press, New York 2008.
  5. Nathan PE, Gorman JM. A Guide to Treatments That Work, 2nd ed, Oxford University Press, New York 2002.
  6. Wilson GT, Grilo CM, Vitousek KM. Psychological treatment of eating disorders. Am Psychol 2007; 62:199.
  7. Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive behavioral therapy for eating disorders. Psychiatr Clin North Am 2010; 33:611.
  8. Pike KM, Carter JC, Olmsted MP. Cognitive-behavioral therapy for anorexia nervosa. In: The Treatment of Eating Disorders: A Clinical Handbook, Grilo CM, Mitchell JE. (Eds), The Guilford Press, New York 2010. p.83.
  9. American Psychiatric Association. Treatment of patients with eating disorders,third edition. American Psychiatric Association. Am J Psychiatry 2006; 163:4.
  10. National Institute for Clinical Excellence. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Clinical Practice Guideline Number CG9. 2004. http://guidance.nice.org,uk (Accessed on January 27, 2012).
  11. Pike KM, Walsh BT, Vitousek K, et al. Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. Am J Psychiatry 2003; 160:2046.
  12. Carter JC, McFarlane TL, Bewell C, et al. Maintenance treatment for anorexia nervosa: a comparison of cognitive behavior therapy and treatment as usual. Int J Eat Disord 2009; 42:202.
  13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  14. Work Group on Psychiatric Evaluation, American Psychiatric Association Steering Committee on Practice Guidlines. Psychiatric evaluation of adults. Second edition. American Psychiatric Association. Am J Psychiatry 2006; 163:3.
  15. American Psychiatric Association Practice Guideline for the Psychiatric Evaluation of Adults, Second Edition, 2006. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on July 18, 2011).
  16. Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry 2014; 48:977.
  17. NICE National Institute for Health and Care Excellence. Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical guideline 9. January 2004. http://www.nice.org.uk/guidance/cg9/ (Accessed on June 10, 2015).
  18. Hay P. A systematic review of evidence for psychological treatments in eating disorders: 2005-2012. Int J Eat Disord 2013; 46:462.
  19. Watson HJ, Bulik CM. Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions. Psychol Med 2013; 43:2477.
  20. Zipfel S, Wild B, Groß G, et al. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 2014; 383:127.
  21. McIntosh VV, Jordan J, Carter FA, et al. Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry 2005; 162:741.
  22. Carter FA, Jordan J, McIntosh VV, et al. The long-term efficacy of three psychotherapies for anorexia nervosa: a randomized, controlled trial. Int J Eat Disord 2011; 44:647.
  23. Touyz S, Le Grange D, Lacey H, et al. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med 2013; 43:2501.
  24. Halmi KA, Agras WS, Crow S, et al. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry 2005; 62:776.
  25. Walsh BT, Kaplan AS, Attia E, et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA 2006; 295:2605.
  26. Attia E. Anorexia nervosa: current status and future directions. Annu Rev Med 2010; 61:425.
  27. Fairburn CG, Harrison PJ. Eating disorders. Lancet 2003; 361:407.
  28. Hay P, Bacaltchuk J, Claudino A, et al. Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev 2003; :CD003909.
  29. Brown A, Mountford V, Waller G. Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa. Behav Res Ther 2013; 51:216.
  30. Stiles-Shields C, Touyz S, Hay P, et al. Therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa. Int J Eat Disord 2013; 46:783.
  31. Vitousek K, Watson S, Wilson GT. Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 1998; 18:391.
  32. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992; 47:1102.
  33. Wade TD, Frayne A, Edwards SA, et al. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry 2009; 43:235.
  34. Kaplan AS, Walsh BT, Olmsted M, et al. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med 2009; 39:1037.
  35. Field AE, Cheung L, Wolf AM, et al. Exposure to the mass media and weight concerns among girls. Pediatrics 1999; 103:E36.
  36. Christodoulou M. Pro-anorexia websites pose public health challenge. Lancet 2012; 379:110.
  37. Shafran R, Fairburn CG, Robinson P, Lask B. Body checking and its avoidance in eating disorders. Int J Eat Disord 2004; 35:93.
  38. Davis C, Katzman DK, Kaptein S, et al. The prevalence of high-level exercise in the eating disorders: etiological implications. Compr Psychiatry 1997; 38:321.
  39. Arcelus J. The Loughborough Eating Disorders Activity Program (LEAP), The International Conference on Eating Disorders, April 28, 2011.
  40. Wright JH, Sudak DM, Turkington D, Thase ME. Targeting maladative thinking. In: High Yield Cognitive-Behavior Therpay for Brief Sessions: An Illustrated Guide, American Psychiatric Publishing, Inc., Washington, DC 2010. p.113.
  41. Bemis KM. A comparison of functional relationships in anorexia nervosa and phobia. In: Anorexia Nervosa: Recent Developments, Darby PL, Garfinkel PE, Garner DM, Cascina DV (Eds), Alan R Liss, New York 1983.
  42. Striegel-Moore R, McAvay G, Rodin J, Allen PR. Psychological and behavioral correlates of feeling fat in women. Int J Eat Disord 1986; 5:935.
  43. Vitousek KB, Hollon SD. The investigation of schematic content and processing in eating disorders. Cognit Ther Res 1990; 14:191.
  44. Young J. Schema-focused cognitive therapy for personality disorders. In: Cognitive Therapy for Personality Disorders, Beck AT, Freeman A (Eds), Guilford Press, New York 1990.
  45. Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder, Guilford Press, New York 1993.
  46. Carter JC, Blackmore E, Sutandar-Pinnock K, Woodside DB. Relapse in anorexia nervosa: a survival analysis. Psychol Med 2004; 34:671.
  47. Eckert ED, Halmi KA, Marchi P, et al. Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychol Med 1995; 25:143.
  48. Eisler I, Dare C, Russell GF, et al. Family and individual therapy in anorexia nervosa. A 5-year follow-up. Arch Gen Psychiatry 1997; 54:1025.
  49. Keel PK, Dorer DJ, Franko DL, et al. Postremission predictors of relapse in women with eating disorders. Am J Psychiatry 2005; 162:2263.
  50. Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. Int J Eat Disord 1997; 22:339.
  51. Castro J, Gila A, Puig J, et al. Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa. Int J Eat Disord 2004; 36:22.
  52. Steinhausen HC, Grigoroiu-Serbanescu M, Boyadjieva S, et al. The relevance of body weight in the medium-term to long-term course of adolescent anorexia nervosa. Findings from a multisite study. Int J Eat Disord 2009; 42:19.
  53. Treat TA, McCabe EB, Gaskill JA, Marcus MD. Treatment of anorexia nervosa in a specialty care continuum. Int J Eat Disord 2008; 41:564.
  54. McFarlane T, Olmsted MP, Trottier K. Timing and prediction of relapse in a transdiagnostic eating disorder sample. Int J Eat Disord 2008; 41:587.
  55. Lock JD, Fitzpatrick KK. Anorexia nervosa. BMJ Clin Evid 2009; 2009.
  56. Fairburn C. Cognitive Behavior Therapy and Eating Disorders, The Guilford Press, New York 2008.