for Bulimia Nervosa
CHRISTOPHER G. FAIRBURN
A specific form of cognitive-behavioral therapy (CBT) is the leading evidence-based treatment for bulimia nervosa and is widely accepted as the treatment of choice. In this chapter, the theory underpinning the treatment is first described. Then, the treatment is outlined and the data on its effectiveness are presented. Finally, future developments are discussed. (The cognitive-behavioral treatment of anorexia nervosa is discussed in Chapter 55.)
A characteristic cognitive disturbance is a prominent feature of anorexia nervosa and bulimia nervosa, and it has long been regarded as their “core psychopathology.” In both disorders, thinness and weight loss are sought, and there are strenuous attempts to avoid weight gain and any perceived “fatness.” At the heart of this psychopathology is the tendency to judge self-worth largely, or even exclusively, in terms of eating, shape and weight, and their control. Rather than evaluating self-worth on the basis of perceived performance in a variety of domains (e.g., interpersonal relationships, work, parenting, sport, artistic ability, etc.), people with anorexia nervosa and bulimia nervosa evaluate themselves primarily in terms of their eating, shape, and weight.
To a varying degree, there may be other, more general, forms of cognitive disturbance, the most common of which is low self-esteem. Many of these patients have deepseated and long-standing doubts about their self-worth. These doubts encourage selfevaluation in terms of controlling eating, shape, and weight, since dieting and weight loss are socially reinforced in women, and since appearance, and especially weight, seem more