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Eating Disorders

People with eating disorders experience significant alterations in their relationships with food. For example, individuals with anorexia nervosa restrict their food intake and individuals with bulimia nervosa experience episodes of binge eating followed by efforts to avoid gaining weight, including vomiting or excessive exercise. Cognitive behavioral therapy (CBT) and family-based therapy (FBT) are both evidence-based treatments for eating disorders. Read more
Eating Disorders
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A Guide To Emotions (Psychology Tools For Living Well)

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ... https://www.psychologytools.com/resource/a-guide-to-emotions-psychology-tools-for-living-well

All-Or-Nothing Thinking

All-or-nothing thinking (often also referred to as ‘black and white thinking’, ‘dichotomous thinking’, ‘absolutist thinking’, or ‘binary ... https://www.psychologytools.com/resource/all-or-nothing-thinking

Am I Experiencing Anorexia?

Anorexia (anorexia nervosa) is a condition characterized by the restriction of energy (food) intake relative to requirements, leading to a significant ... https://www.psychologytools.com/resource/am-i-experiencing-anorexia

Am I Experiencing Bulimia?

Bulimia (bulimia nervosa) is a condition characterized by recurrent episodes of binge eating, accompanied by repeated inappropriate compensatory behav ... https://www.psychologytools.com/resource/am-i-experiencing-bulimia

Avoidance Hierarchy (Archived)

NOTE: An improved version of this resource is available here: Fear Ladder. Older versions of a resource may be archived in the event that they are ava ... https://www.psychologytools.com/resource/avoidance-hierarchy

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format

Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)

Anorexia nervosa is an eating disorder characterized by restriction of energy intake and intense fear of gaining weight. For women, the lifetime preva ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-anorexia-nervosa-fairburn-cooper-shafran-2003

Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)

Bulimia nervosa is an eating disorder characterized by binge eating followed by purging. Among young women, the point prevalence of bulimia is about 1 ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-bulimia-nervosa-fairburn-cooper-shafran-2003

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive distortions (or ‘unhelpful thinking styles’) are ways that our thoughts become biased. Different cognitive biases are associated with di ... https://www.psychologytools.com/resource/cognitive-distortions-unhelpful-thinking-styles-common

Cognitive Distortions – Unhelpful Thinking Styles (Extended)

Cognitive distortions (or ‘unhelpful thinking styles’) are ways that our thoughts become biased. Different cognitive biases are associated with di ... https://www.psychologytools.com/resource/cognitive-distortions-unhelpful-thinking-styles-extended

Demanding Standards – Living Well With Your Personal Rules

Demanding Standards – Living Well With Your Personal Rules is a guide written for clients who have high or perfectionistic standards which cause th ... https://www.psychologytools.com/resource/demanding-standards-living-well-with-your-personal-rules

Discounting In Perfectionism – The Ratchet Effect

When individuals with perfectionism successfully meet their demanding standards, these accomplishments are often discounted as “easy to do,” “no ... https://www.psychologytools.com/resource/discounting-in-perfectionism-the-ratchet-effect

Eating And Your Energy Levels

The Eating and Your Energy Levels handout provides an overview of the relationship between food intake and energy levels. It graphically illustrates h ... https://www.psychologytools.com/resource/eating-and-your-energy-levels

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty

Evaluating Your Demanding Standards

Striving to meet demanding standards can be a rewarding process and lead to significant gains. However, demanding standards can also have adverse cons ... https://www.psychologytools.com/resource/evaluating-your-demanding-standards

Exploring Your Demanding Standards

The Exploring Your Demanding Standards worksheet is designed to help clients examine a demanding standard, including its advantages and disadvantages. ... https://www.psychologytools.com/resource/exploring-your-demanding-standards

Identifying Your Demanding Standards

Striving to meet demanding standards can be a rewarding process and lead to significant gains (e.g., praise, social status, financial rewards, etc.). ... https://www.psychologytools.com/resource/identifying-your-demanding-standards

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record

Mental Filter

The Mental Filter information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/mental-filter

Overcoming Eating Disorders (Second Edition): Therapist Guide

Overcoming Eating Disorders comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the Client Workbook.&nbs ... https://www.psychologytools.com/resource/overcoming-eating-disorders-therapist-guide

Overcoming Your Eating Disorder: Workbook

Overcoming Eating Disorders comes in two volumes. This page is for the Client Workbook. Click on the following link to access the accompanying Therapi ... https://www.psychologytools.com/resource/overcoming-your-eating-disorder-workbook

Overgeneralization

The Overgeneralization information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effect ... https://www.psychologytools.com/resource/overgeneralization

Permissive Thinking

The Permissive Thinking information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/permissive-thinking

Permissive Thinking – Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/permissive-thinking-self-monitoring-record

Personalizing

The Personalizing information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/personalizing

Recognizing Anorexia Nervosa

Anorexia Nervosa is characterized by the restriction of energy intake, leading to a severely low weight in the context of an individual’s age, heigh ... https://www.psychologytools.com/resource/recognizing-anorexia-nervosa

Recognizing Binge Eating Disorder

Binge Eating Disorder is characterized by frequent and recurrent episodes of binge eating, which is defined as a period of time in which the individua ... https://www.psychologytools.com/resource/recognizing-binge-eating-disorder

Recognizing Bulimia Nervosa

Bulimia Nervosa is characterized by frequent and recurrent episodes of binge eating, which are defined as a period of time in which the individual exp ... https://www.psychologytools.com/resource/recognizing-bulimia-nervosa

Social Comparison

The Social Comparison information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effecti ... https://www.psychologytools.com/resource/social-comparison

Starvation Syndrome – The Effects of Semi-Starvation

The Starvation Syndrome – Effects of Semi-Starvation handout provides an overview of the Minnesota Starvation Experiment and common symptoms of semi ... https://www.psychologytools.com/resource/starvation-syndrome-the-effects-of-semi-starvation

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal

Thought-Action Fusion

The Thought-Action Fusion information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/thought-action-fusion

Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 2003)

Fairburn, Cooper & Shafran (2003) argue that eating disorders such as anorexia and bulimia share common maintenance mechanisms despite difference ... https://www.psychologytools.com/resource/transdiagnostic-cognitive-behavioral-model-of-eating-disorders-fairburn-cooper-shafran-2003

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record

Understanding Anorexia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-anorexia

Understanding Bulimia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-bulimia

Unhelpful Thinking Styles (Archived)

NOTE: Two improved versions of this resource are available here: Cognitive Distortions – Unhelpful Thinking Styles (Common) and Cognitive Disto ... https://www.psychologytools.com/resource/unhelpful-thinking-styles-archived

What Is Anorexia?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-anorexia

What Is Bulimia?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ... https://www.psychologytools.com/resource/what-is-bulimia

What Is Compassion Focused Therapy (CFT)?

Compassion focused therapy (CFT) was developed to work with issues of shame and self-criticism. The CFT model complements and expands the traditional ... https://www.psychologytools.com/resource/what-is-compassion-focused-therapy-cft

What Keeps Anorexia Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-anorexia-going

What Keeps Bulimia Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-bulimia-going

Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

Links to external resources

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

Assessment

  • Eating Attitudes Test 26 (EAT-26) | Garner, Olmsted, Bohr, Garfinkel | 1982
  • Eating Disorder Examination (EDE) | Fairburn, Cooper, O’Connor | 2014
  • ED15 | Tatham, Turner, Mountford, Tritt, Dyas, Waller | 2015
    • Scale
    • Reference Tatham, M., Turner, H., Mountford, V. A., Tritt, A., Dyas, R., & Waller, G. (2015). Development, psychometric properties and preliminary clinical validation of a brief, session‐by‐session measure of eating disorder cognitions and behaviors: The ED‐15. International Journal of Eating Disorders, 48(7), 1005-1015.
  • Assessment Of Eating Disorders: Review And Recommendations For Clinical Use | Anderson, Lundgren, Shapiro, Paulosky | 2004

Exercises

Guides and workbooks

  • Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR): patient and family workbook | Thomas, J.J, Eddy, K.T | 2019
  • Self-help manual for bulimia nervosa | Freeman, Downey | 2001
  • Taming the hungry bear: Your way to recover from chaotic overeating | Kate Williams

Information Handouts

Information (Professional)

Presentations

  • Evidence-based cognitive behavioural therapy for eating disorders: principles and practice | Glenn Waller | 2017
  • Putting the ‘B’ back into CBT for eating disorders | Glen Waller | 2011
  • Transdiagnostic CBT for eating disorders “CBT-E” | Chris Fairburn | 2016

Self-Help Programmes

Treatment Guide

  • Eating Disorders: Recognition And Treatment (NICE Guideline) | NICE | 2020
  • Maudsley Service Manual For Child And Adolescent Eating Disorders | Eisler, Simic, Blessitt, Dodge | 2016
  • Eating disorders: recognition and treatment | National Institute for Health and Care Excellence (NICE) | 2020
  • Group cognitive remediation therapy for adolescents with anorexia nervosa: The flexible thinking group | Maiden, Baker, Espie, Simic, Tchanturia | 2014

Video

  • Eating disorders from the inside out | Dr Laura Hill | 2012

Worksheets

Recommended Reading

  • Cooper, Z., Fairburn, C. (2009). Management of bulimia nervosa and other binge-eating problems. Advances in Psychiatric Treatment, 15, 129-136
  • Cooper, Z., & Fairburn, C. G. (2011). The evolution of “enhanced” cognitive behavior therapy for eating disorders: Learning from treatment nonresponse. Cognitive and behavioral practice, 18(3), 394-402
  • Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics of North America, 33(3), 611-627
  • Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: Understanding the overlap. Clinical psychology review, 28(3), 366-386.
  • Wade, T. D., Shafran, R., Cooper, Z. (2023). Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders. International Journal of Eating Disorders
  • Waller, G. (2016). Recent advances in psychological therapies for eating disorders. F1000Research, 5.

What Are Eating Disorders?

Signs and Symptoms of Eating Disorders

Common to many of the eating disorders are a preoccupation with weight and body shape, significant anxiety about gaining weight, and behaviors intended to mitigate the anxiety.

Symptoms of anorexia nervosa may include:

  • restriction of energy intake leading to weight that is less than minimally normal or expected in the context of age, sex, developmental trajectory, and physical health;
  • an intense fear of gaining weight, an intrusive dread of fatness, or persistent behavior that interferes with weight gain;
  • disturbed perception of one’s body weight (e.g., a self-perception of being too fat);
  • self-evaluation is unduly influenced by body weight or shape;
  • a persistent lack of insight regarding the seriousness of low body weight;
  • endocrine disorder resulting in amenorrhea or loss of sexual interest or potency.

Symptoms of bulimia nervosa include:

  • recurrent episodes of binge eating (overeating) where excessively large amounts of food are consumed in a discrete period of time;
  • a feeling of lack of self-control over eating during a binge-eating episode;
  • recurrent behaviors to counteract weight gain such as self-induced vomiting, purging, fasting, use of drugs, diuretics, or excessive exercise;
  • self-evaluation is unduly influenced by body weight or shape;
  • a self-perception of being too fat and an intrusive dread of fatness.

Psychological Models and Theory of Eating Disorders

Fairburn, Cooper, and Shafran (2003) proposed a transdiagnostic cognitive behavioral model of eating disorders that describes the maintenance of both anorexia nervosa and bulimia nervosa. Central to the model is the individual’s judgment of their self-worth in terms of body weight or shape. Disordered eating behaviors are understood as a consequence of these self-beliefs.

Evidence-Based Psychological Approaches for Working with Eating Disorders

Enhanced Cognitive Behavior Therapy for Eating Disorder (CBT-E)

In 2003, Fairburn et al. argued for value in viewing eating disorders from a transdiagnostic perspective. They say that common mechanisms, such as a restricted assessment of self-worth, underpinned both anorexia and bulimia. CBT-E includes elements that focus on modification of eating habits, weight-control behavior, and concerns about eating, shape, and weight.

Family-Based Treatment (FBT) / Maudsley Family Therapy

FBT is an outpatient, intensive treatment in which the family is used as the primary resource to renourish the affected child or adolescent. It is described as a highly practical approach that attempts to modify problems in family structure that make refeeding more difficult (Lock and le Grange, 2005). Average length of treatment is 9–12 months. A 2013 meta-analysis indicated that individual therapy and FBT were equivalently effective at the end of treatment, but that FBT was superior at 6–12 month follow-up (Couturier, Kimber, & Szatmari, 2013).

Resources for Working with Eating Disorders

Psychology Tools resources available for working therapeutically with eating disorders may include:

  • psychological models of eating disorders including anorexia and bulimia
  • information handouts for eating disorders including anorexia and bulimia
  • exercises for eating disorders including anorexia and bulimia
  • CBT worksheets for eating disorders including anorexia and bulimia
  • self-help programs for eating disorders including anorexia and bulimia

References

  • Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of family‐based treatment for adolescents with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 46(1), 3–11.
  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviourtherapy for eating disorders: A ‘transdiagnostic’ theory and treatment. BehaviourResearch and Therapy, 41(5), 509–528.
  • Lock, J., & le Grange, D. (2005). Family‐based treatment of eating disorders. International Journal of Eating Disorders, 37(S1), S64–S67.