Chipur Update | Anorexia, Eating Disorders, and a Smokin’ CBT


The mood and anxiety disorders are rarely just “the mood and anxiety disorders.” Right? How well we know there always seems to be those value-added options. Speaking of which, let’s chat anorexia, eating disorders, and a smokin’ cognitive behavioral therapy.

One psychological treatment that seems particularly promising is Enhanced Cognitive Behavioral Therapy (CBT-E). Oxford University psychologist Christopher Fairburn and his colleagues have made impressive strides with their recent treatment research in Europe…

Was spending some time this past week flickin’ through the usual sources for learnin’. An article on anorexia and the eating disorders caught my eye.

I posted a three part need-to-know series on the eating disorders some three-and-a-half years ago. But given National Eating Disorders Awareness Week ended February 28, I knew it was time for an update.

First, some stats…

  • Up to 24 million people of all ages – female and male – are enduring an eating disorder in the U.S.
  • Eating disorders have the highest mortality rate of the emotional/mental disorders
  • Compared to “healthy” peers, women with anorexia are up to 12 times more likely to die of any cause, and approximately 57 times more likely to die from suicide, over the same period of time
  • Just 1 in 10 with an eating disorder receive treatment
  • An estimated 10-15% of people with anorexia or bulimia are male
  • Anorexia is the third most common chronic illness among adolescents
  • Almost 50% of those with eating disorders meet the criteria for depression

Anorexia Q & A

In response to National Eating Disorders Awareness Week, the Philadelphia College of Osteopathic Medicine presented this anorexia Q & A with Stacey C. Cahn, PhD, associate professor of psychology. For the sake of space, I’ve done some careful deleting…

What causes some people to develop anorexia?

Someone with a first-degree relative who’s had anorexia is at much greater risk. So individuals have varying levels of biological ‘predisposition’ to anorexia. General risk factors include low mood, a history of physical and sexual trauma, general family problems, and a parent with a psychiatric disorder.

Specific risk factors for anorexia include: being female, age (early-mid adolescence is prime time for onset), perfectionism, high parental conflict, highly demanding parents, and concerns about shape and weight (and subsequent dieting). Shape and weight concerns may be intensified by participation in competitive sports such as gymnastics, track, swimming, or dance – where shape and weight are often related to performance.

Why is anorexia more prevalent in women?

We don’t really know for sure. Anorexia is relatively uncommon – historically, only about 0.3 percent of the population suffers from anorexia. Of those who suffer from anorexia, only about 10 percent are male. It’s hard to get good data on a population that small. It does seem that cultural factors at least partially explain this gender discrepancy. Thinness is more central to our culture’s ‘feminine beauty ideal’ – there’s not an equivalent standard for men. Accordingly, men, overall, have less dissatisfaction with their bodies, and are therefore less likely than females to diet for weight loss, even if they are overweight. This disparity is significant because body dissatisfaction and dieting are risk factors for anorexia.

Are there any promising new treatments in development?

Anorexia is notoriously difficult to research and treat. Treatment effectiveness has generally been disappointing due to a host of factors including the ambivalence about recovery intrinsic to the disorder.

One psychological treatment that seems particularly promising is Enhanced Cognitive Behavioral Therapy (CBT-E). Oxford University psychologist Christopher Fairburn and his colleagues have made impressive strides with their recent treatment research in Europe – they’ve conducted rigorous clinical trials testing CBT-E for adolescents and adults with anorexia. Compared to earlier treatment outcome studies, a remarkable number of those who completed the treatment had maintained their gains five years after treatment.

Still, the most important predictor of positive outcome in anorexia is early identification and intervention. In general, the longer the duration of illness before treatment, the worse the prognosis.

Enhanced Cognitive Behavioral Therapy (CBT-E)

So let’s dig-in to CBT-E just a bit. But, first, I gotta’ say how cool it is that good-old-fashioned (at times boring) cognitive behavioral therapy has taken-on customized faces. In addition to this enhanced version, there’s CBT-I (insomnia), Dialectical Behavior Therapy (DBT), and more.

Okay, CBT-E is a “transdiagnostic” (approach to understanding psych disorders outside the structure of diagnosis) highly individualized treatment specifically for eating disorders. With those who aren’t significantly underweight, CBT-E typically involves an initial assessment, followed by 20 50-minute treatment sessions over 20 weeks. With people who are underweight treatment needs to be longer, often involving some 40 sessions over 40 weeks.

Here are CBT-Es Four Stages

  1. Gaining a mutual understanding of the eating problem and helping the individual modify and stabilize their pattern of eating. There’s also emphasis on personalized education and addressing concerns about weight.
  2. A brief stage in which progress is systematically reviewed and plans are made for the main body of treatment.
  3. A series of weekly sessions focused upon processes that are maintaining the person’s eating problem. Usually involves addressing concerns about shape and eating, enhancing the ability to deal with day-to-day events and moods, and addressing overcontrolled and uncontrolled eating. Toward the end of this stage emphasis shifts to the future.
  4. Continued emphasis upon the future, with focus on maintaining changes that have been obtained and minimizing relapse risk – short and long-term.

Generally a review session is held several months after completion of treatment, during which remaining or emerging problems are addressed.

That’ll Do It

Yep, rarely are the mood and anxiety disorders just “the mood and anxiety disorders.” And the eating disorders are often a value-added feature. I’m hoping this quick Chipur update is useful – to you or someone for whom you care.

Oh, earlier I mentioned the three part need-to-know series I posted several years ago. How ’bout some links?

Intro  Cause  Treatment

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