Psychological treatment of eating disorders.

Abstract

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed.

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study

“…All cases initially diagnosed as BN and bulimic-type EDNOS using the DSM-IV [31] criteria were re-categorized with the new DSM-5 criteria [30] on the basis of information from the interview records [34]. 2 …”

“…A considerable treatment literature has been published on bulimia nervosa (BN) [1,2], which is marked by a chronic and relapse-ridden course, can result into serious medical complications, and is associated with severe comorbid psychopathology and functional impairment [3,4]. The bulk of this literature has focused on the use of cognitive-behavioural therapy (CBT), which is widely considered as the treatment of choice for BN [1,2,5].…”

“…The bulk of this literature has focused on the use of cognitive-behavioural therapy (CBT), which is widely considered as the treatment of choice for BN [1,2,5]. The theory [6] that underpins and guides CBT [7] is primarily concerned with the psychopathological processes that account for the persistence of the disorder.…”

“…Due to the psychological and physiological effects of dietary restraint, when these inflexible dietary rules, which are extremely difficult to maintain, are broken, all attempts to control eating are abandoned and a binge occurs [6]. Although several randomised controlled trials have shown that CBT is more effective than a wide range of alternative treatments [1,2,5,11], amongst BN treatment completers, only 40-50 % have a full and lasting response [12][13][14]. The developers of the original CB theory argued that four additional factors might account for the persistence of dysfunctional cognitions (OSW) and eating-disordered behaviours in some patients that present obstacles for change: (a) interpersonal problems; (b) core low selfesteem; (c) clinical perfectionism; and (d) mood intolerance [12,13].…”

Guided Self-Help Treatment for Recurrent Binge Eating: Replication and Extension

“…Research supports the efficacy of cognitive-behavioral therapy (CBT) treatments (11,13–15), including lower-intensity interventions such as CBT-based guided self-help (CBT-GSH). The latter interventions are well suited for use in everyday practice settings (16,17).…”