for Anorexia Nervosa
KELLY BEMIS VITOUSEK
In the persistent absence of data, “best practice” standards for the treatment of anorexia nervosa continue to be defined by the “best guess” opinions of experts rather than the “best evidence” criteria of research. In this unsatisfactory context, cognitive-behavioral therapy (CBT) represents an educated guess. The approach is a strong candidate for inclusion in clinical trials and a defensible interim choice for clinicians, who clearly cannot defer treating anorexic patients until these trials are completed.
A CBT model for understanding and treating this disorder was first described by Garner and Bemis in 1982, and further elaborated in a series of papers that specified some components of the complex treatment package. Until the past few years, the treatment was virtually untested—a state of affairs that contrasts sharply with the extensive study of Fairburn’s CBT for bulimia nervosa (see Chapter 54) but matches the general status of treatment research in anorexia nervosa. Recently, this area has been invigorated by proposals for shifts in emphasis in the basic CBT model, offered both by its originators and other CBT experts in the eating disorder field. Like the initial approach, however, these suggested revisions are based on clinical experience rather than accumulated evidence about the strengths or weaknesses of existing models. Since we know very little about how well the “traditional” CBT approach to anorexia nervosa works, how it might be improved remains a matter of conjecture.
Cognitive models focus on the variables that initiate and maintain anorexic symptoms rather than on remote etiological factors. According to cognitive theories, the core disturbance is a characteristic set of beliefs associated with the desire to control eating and weight. A fundamental premise is that the worth of the self is represented in the size and