Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-02T00:46:14.555Z Has data issue: false hasContentIssue false

39 - Psychological treatments for eating disorders

from Part III - Specific treatments

Published online by Cambridge University Press:  12 May 2010

By
Roz Shafran ,
Pamela K. Keel ,
Alissa Haedt  and
Christopher Fairburn
Edited by
Peter Tyrer  and
Kenneth R. Silk
Roz Shafran
Affiliation:
Department of Psychiatry Oxford University Warneford Hospital Oxford UK
Pamela K. Keel
Affiliation:
Department of Psychology University of Iowa Iowa City, IA USA
Alissa Haedt
Affiliation:
Department of Psychology University of Iowa Iowa City, IA USA
Christopher Fairburn
Affiliation:
Department of Psychiatry Oxford University Warneford Hospital Oxford UK
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk
Affiliation:
University of Michigan, Ann Arbor
Get access

Summary

Editor's note

Psychological treatments are now the cornerstone of treatment for eating disorders, with cognitive behaviour therapy having pride of place. This chapter, in conjunction with Chapter 23, shows the importance of setting as a likely determinant of effective treatment, and the relatively limited knowledge we have on the subject. The chapter also illustrates a common problem when the preferred treatment is found to be ineffective; there is often no evidence base for any alternative strategy. The chapter is also a useful reminder not to be too rigid in linking diagnosis to treatment in eating disorders. The frequent changing from one eating diagnosis to another, and the common presentation of EDNOS (eating diorders not otherwise specified) shows the relative lack of utility of the current descriptions when it comes to selecting treatment.

Introduction

It is the task of this chapter to evaluate the evidence on the psychological treatment of eating disorders. The strength of the evidence base for the treatment of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and remaining eating disorders not otherwise specified (EDNOS; or atypical eating disorders (AEDs)) varies, so each eating disorder will be considered separately. Examination of the evidence base requires the identification and appraisal of the relevant research findings. This has already been done in the UK by the National Institute for Health and Clinical Excellence (NICE) (National Collaborating Centre for Mental Health, 2004), which is the primary source of information on which this chapter is based.

Type
Chapter
Information
Cambridge Textbook of Effective Treatments in Psychiatry , pp. 628 - 636
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agras, W. S., Walsh, B. T., Fairburn, C. G., Wilson, G. T. & Kraemer, H. C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459–66.Google Scholar
Agras, W. S., Brandt, H. A., Bulik, C. M.et al. (2004). Report of the National Institutes of Health workshop on “Overcoming Barriers to Treatment Research in Anorexia Nervosa.” International Journal of Eating Disorders, 35, 509–21.Google Scholar
American Psychiatric Association (APA) (2000). Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 157 (suppl. 1), 1–39.
Bara-Carril, N., Williams, C. J., Pombo-Carril, M. G.et al. (2004). A preliminary investigation into the feasibility and efficacy of a CD-ROM-based cognitive-behavioral self-help intervention for bulimia nervosa. International Journal of Eating Disorders, 35, 538–48.Google Scholar
Bulik, C. M., Sullivan, P. F., Carter, F. A., McIntosh, V. C. & Joyce, P. R. (1998). The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa. Psychological Medicine, 28, 611–23.Google Scholar
Cachelin, F. M., Striegel-Moore, R. H., Elder, K. A., Pike, K. M., Wilfley, D. E. & Fairburn, C. G. (1999). Natural course of a community sample of women with binge eating disorder. International Journal of Eating Disorders, 25, 45–54.Google Scholar
Carter, J. C. & Fairburn, C. G. (1998). Cognitive-behavioral self-help for binge eating disorder: a controlled effectiveness study. Journal of Consulting and Clinical Psychology, 66, 616–23.Google Scholar
Carter, J. C., Olmsted, M. P., Kaplan, A. S., McCabe, R. E., Mills, J. S. & Aime, A. (2003). Self-help for bulimia nervosa: a randomized controlled trial. American Journal of Psychiatry, 160, 973–8.Google Scholar
Channon, S., Silva, P., Hemsley, D. & Perkins, R. (1989). A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa. Behaviour Research and Therapy, 27, 529–35.Google Scholar
Chen, E., Touyz, S. W., Beumont, P.et al. (2003). Comparison of group and individual cognitive-behavioral therapy for patients with bulimia nervosa. International Journal of Eating Disorder, 33, 241–54.Google Scholar
Cooper, P. J. & Steere, J. (1995). A comparison of two psychological treatments for bulimia nervosa: implications for models of maintenance. Behaviour Research and Therapy, 33, 875–85.Google Scholar
Cooper, P. J., Coker, S. & Fleming, C. (1996). An evaluation of the efficacy of supervised cognitive behavioral self-help bulimia nervosa. Journal of Psychosomatic Research, 40, 281–7.Google Scholar
Crisp, A. H., Norton, K., Gowers, S.et al. (1991). A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. British Journal of Psychiatry, 159, 325–33.Google Scholar
Dare, C., Eisler, I., Russell, G., Treasure, J. & Dodge, L. (2001). Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. British Journal of Psychiatry, 178, 216–21.Google Scholar
Dingemans, A. E., Bruna, M. J. & Furth, E. F. (2002). Binge eating disorder: a review. International Journal of Obesity, 26, 299–307.Google Scholar
Eisler, I., Dare, C., Russell, G. F. M., Szmukler, G., leGrange, D., & Dodge, E. (1997). Family and individual therapy in anorexia nervosa – a 5-year follow-up. Archives of General Psychiatry, 54, 1025–30.Google Scholar
Fairburn, C. G. (1981). A cognitive behavioral approach to the treatment of bulimia. Psychological Medicine, 11, 707–11.Google Scholar
Fairburn, C. G. (1997). Eating disorders. In Science and Practice of Cognitive Behaviour Therapy, ed. Clark, D. M. & Fairburn, C. G., pp. 209–41. Oxford: Oxford University Press.
Fairburn, C. G. & Harrison, P. J. (2003). Eating disorders. Lancet, 361, 407–16.Google Scholar
Fairburn, C. G. & Bohn, K. (2005a). Eating Disorder Not Otherwise Specified (EDNOS): an example of the troublesome “Not Otherwise Specified (NOS)” category in DSM IV. Behaviour Research and Therapy, 43(6), 691–701.Google Scholar
Fairburn, C. G. & Bohn, K. (2005b). Evidence-based treatment of anorexia nervosa. International Journal of Eating Disorders, 37 Suppl. 526–30.Google Scholar
Fairburn, C. G., Jones, R., Peveler, R. C., Hope, R. A. & O'Connor, M. E. (1993a). Psychotherapy and bulmia nervosa: longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive-behavior therapy. Archives of general Psychiatry, 50, 419–28.Google Scholar
Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993b). Cognitive behavioral therapy for binge eating and bulimia nervosa: a comprehensive treatment manual. In Binge Eating: Nature, Assessment and Treatment, ed. Fairburn, C. G., Wilson, G. T., pp. 361–404. New York: Guilford Press.
Fairburn, C. G., Cooper, Z., Doll, H. A., Norman, P. & O'Connor, M. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57, 659–65.Google Scholar
Fairburn, C. G., Cooper, Z. & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–28.Google Scholar
Freeman, C., Barry, F., Dunkeld-Turnbull, J. & Henderson, (1988). Controlled trial of psychotherapy for bulmia nervosa. British Medical Journal, 296, 521–5.Google Scholar
Garvin, V., Streigel-Moore, R. H. & Wells, A. M. (1998). Participant reactions to a cognitive-behavioral guided self-help program for binge eating: developing criteria for program evaluation. Journal of Psychosomatic Research, 44, 407–12.Google Scholar
Hall, A. & Crisp, A. H. (1987). Brief psychotherapy in the treatment of anorexia nervosa. Outcome at one year. British Journal of Psychiatry, 151, 185–91.Google Scholar
Herzog, T., Hartmann, A. & Falk, C. (1996). The short-term effects of psychodynamic inpatient treatment of anorexia nervosa with and without an explicit focus on eating pathology – a controlled study. Psychotherapie Psychosomatik Medizinische Psychologie, 46, 11–22.Google Scholar
Kaye, W. H., Nagata, T., Weltzin, T. E.et al. (2001). Double-blind placebo-controlled administration of fluoxetine in restricting-and restricting-purging-type anorexia nevosa. Biological Psychiatry, 49(7), 644–52.Google Scholar
Keel, P. K. (2004). Commentary on a multi-dimensional meta-analysis of psychotherapy for bulimia nervosa. Evidence Based Mental Health, 7, 11.Google Scholar
Keel, P. K., Fichter, M., Quadflieg, N.et al. (2004). Application of a latent class analysis to empirically define eating disorder phenotypes. Archives of General Psychiatry, 61, 192–200.Google Scholar
Keel, P. K., Mayer, S. A. & Fischer, J. H. (2001). Importance of size in defining binge eating episodes in bulimia nervosa. International Journal of Eating Disorders, 29, 294–301.Google Scholar
Keel, P. K., Heatherton, T. F., Dorer, D. J., Joiner, T. E. & Zalta, A. (2006). Point prevalence of bulimia nervosa in 1982, 1992, and 2002. Psychological Medicine, 36, 119–27.Google Scholar
Kreipe, R. E. & Yussman, S. M. (2003). The role of the primary care practitioner in the treatment of eating disorders. Adolescent Medicine, 14, 133–47.Google Scholar
Loeb, K. L., Wilson, G. T., Gilbert, J. S. & Labouvie, E. (2000). Guided and unguided self-help for binge eating. Behaviour Research and Therapy, 38, 259–72.Google Scholar
Maguire, S., Surgenor, L. J., Abraham, S. & Beumont, P. (2003). An international collaborative database: its use in predicting length of stay for inpatient treatment of anorexia nervosa. Australian and New Zealand Journal of Psychiatry, 37, 741–7.Google Scholar
Mitchell, J. E., Pyle, R. L., Pomeroy, C.et al. (1993). Cognitive-behavioral group psychotherapy of bulimia nervosa: importance of logistical variables. International Journal of Eating Disorders, 14, 277–87.Google Scholar
Nakash-Eisikovits, O., Dierberger, A. & Westen, D. (2002). A multidimensional meta-analysis of pharmacotherapy for bulimia nervosa: summarizing the range of outcomes in controlled clinical trials. Harvard Review of Psychiatry, 10, 193–211.Google Scholar
National Collaborating Centre for Mental Health (2004). Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. London: British Psychological Society and Royal College of Psychiatrists.
National Institute for Clinical Excellence (NICE) (2004). Eating Disorders Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorder. Nice Clinical Guideline No.9. London: National Institute for Clinical Excellence. Available from www.nice.org.uk.
Palmer, R. L., Birchall, H., McGrain, L. & Sullivan, V. (2002). Self-help for bulimic disorders: a randomised controlled trial comparing minimal guidance with face-to-face or telephone guidance. British Journal of Psychiatry, 181, 230–5.Google Scholar
Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T. & Bauer, J. (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry, 160, 2046–9.Google Scholar
Powers, P. S. & Santana, C. A. (2002). Eating disorders: a guide for the primary care physician. Primary Care, 29, 81–98.Google Scholar
Robin, A. L., Siegel, P. T., Moye, A. W., Gilroy, M., Dennis, A. B. & Sikand, A. (1999). A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1482–9.Google Scholar
Russell, G. F. M., Szmukler, G. I., Dare, C. & Eisler, I. (1987). An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 44, 1047–56.Google Scholar
Serfaty, M. A., Turkington, D., Heap, M., Ledsham, L. & Jolley, E. (1999). Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa: effects of the treatment phase. European Eating Disorders Review, 7, 334–50.Google Scholar
Solanto, M. V., Jacobson, M. S., Heller, L., Golden, N. H. & Hertz, S. (1994). Rate of weight gain in inpatients with anorexia nervosa under two behavioral contracts. Pediatrics, 93, 989–91.Google Scholar
Thackwray, D. E., Smith, M. C., Bodfish, J. W. & Meyers, A. W. (1993). A comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa. Journal of Consulting and Clinical Psychology, 61, 639–45.Google Scholar
Thompson-Brenner, H., Glass, S. & Westen, D. (2003). A multidimensional meta-analysis of psychotherapy for bulimia nervosa. Clinical Psychology Science and Practice, 10, 269–87.Google Scholar
Touyz, S. W., Beumont, P. J. V., Glaun, D., Phillips, T. & Cowie, I. (1984). A comparison of lenient and strict operant conditioning programmes in refeeding patients with anorexia nervosa. British Journal of Psychiatry, 144, 517–20.Google Scholar
Treasure, J. L., Todd, G., Brolly, M., Tiller, J., Nehmed, A. & Denman, F. (1995). A pilot study of a randomised trial of cognitive analytical therapy vs educational behaviuoral therapy for adult anorexia nervosa. Behaviour Research and Therapy, 33, 363–7.Google Scholar
Vandereycken, W. (2003). The place of inpatient care in the treatment of anorexia nervosa: questions to be answered. International Journal of Eating Disorders, 34, 409–22.Google Scholar
Vandereycken, W. & Pieters, G. (1978). Short-term weight restoration in anorexia nervosa through operant conditioning. Scandinavian Journal of Behaviour Therapy, 7, 221–36.Google Scholar
Waller, D. & Fairburn, C. G. (2004). Eating disorders. In Women's Health, ed. Waller, D. & McPherson, A., 5th edn. Chapter 15, pp. 519–51. Oxford: Oxford University Press.
Waller, D., Fairburn, C. G., McPherson, A., Kay, R., Lee, A. & Nowell, T. (1996). Treating bulimia nervosa in primary care: a pilot study. International Journal of Eating Disorders, 19, 99–103.Google Scholar
Walsh, B. T., Fairburn, C. G., Mickley, D., Sysko, R. & Parides, M. K. (2004). Treatment of bulimia nervosa in a primary care setting. American Journal of Psychiatry, 161, 556–61.Google Scholar
Wilfley, D. E., Welch, R. R., Stein, R. I.et al. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59(8), 713–21.Google Scholar
Wilson, G. T. & Agras, W. S. (2001). Practice guidelines for eating disorders. Behavior Therapy, 32, 219–34.Google Scholar
Wilson, G. T. & Fairburn, C. G. (2002). Eating disorders. In Treatments that Work, ed. Nathan, P. E. & Gorman, J. M., 2nd edn, pp. 559–92. New York: Oxford University Press.
Wolf, E. M. & Crowther, J. H. (1992). An evaluation of behavioral and cognitive-behavioral group interventions for the treatment of bulimia nervosa in women. International Journal of Eating Disorders, 11, 3–15.Google Scholar
Zipfel, S., Reas, D. L., Thornton, C.et al. (2002). Day hospitalization programs for eating disorders: a systematic review of the literature. International Journal of Eating Disorders, 31, 105–17.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Psychological treatments for eating disorders
    • By Roz Shafran, Department of Psychiatry Oxford University Warneford Hospital Oxford UK, Pamela K. Keel, Department of Psychology University of Iowa Iowa City, IA USA, Alissa Haedt, Department of Psychology University of Iowa Iowa City, IA USA, Christopher Fairburn, Department of Psychiatry Oxford University Warneford Hospital Oxford UK
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Book: Cambridge Textbook of Effective Treatments in Psychiatry
  • Online publication: 12 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544392.041
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Psychological treatments for eating disorders
    • By Roz Shafran, Department of Psychiatry Oxford University Warneford Hospital Oxford UK, Pamela K. Keel, Department of Psychology University of Iowa Iowa City, IA USA, Alissa Haedt, Department of Psychology University of Iowa Iowa City, IA USA, Christopher Fairburn, Department of Psychiatry Oxford University Warneford Hospital Oxford UK
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Book: Cambridge Textbook of Effective Treatments in Psychiatry
  • Online publication: 12 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544392.041
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Psychological treatments for eating disorders
    • By Roz Shafran, Department of Psychiatry Oxford University Warneford Hospital Oxford UK, Pamela K. Keel, Department of Psychology University of Iowa Iowa City, IA USA, Alissa Haedt, Department of Psychology University of Iowa Iowa City, IA USA, Christopher Fairburn, Department of Psychiatry Oxford University Warneford Hospital Oxford UK
  • Edited by Peter Tyrer, Imperial College of Science, Technology and Medicine, London, Kenneth R. Silk, University of Michigan, Ann Arbor
  • Book: Cambridge Textbook of Effective Treatments in Psychiatry
  • Online publication: 12 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544392.041
Available formats
×