A cognitive behavioural theory of anorexia nervosa

Abstract

A cognitive behavioural theory of the maintenance of anorexia nervosa is proposed. It is argued that an extreme need to control eating is the central feature of the disorder, and that in Western societies a tendency to judge self-worth in terms of shape and weight is superimposed on this need for self-control. The theory represents a synthesis and extension of existing accounts. It is `new', not so much because of its content, but because of its exclusive focus on maintenance, its organisational structure and its level of specification. It is suggested that the theory has important implications for treatment.

Introduction

Anorexia nervosa remains a challenge in terms of understanding and treatment. It is still seen by clinicians as ``one of the most frustrating and recalcitrant forms of psychopathology'' (Vitousek et al., in press). There are many different perspectives on the disorder, including sociocultural views, family views, cognitive behavioural accounts and neurobiological perspectives (see Brownell and Fairburn, 1995; Szmukler et al., 1995). Similarly there are many different approaches to its treatment, including family therapy, cognitive behaviour therapy and pharmacotherapy (see Garner and Garfinkel, 1997). Some accounts of the disorder focus on its development; others on its maintenance: often the distinction is either not made or is not clear (Cooper, 1995). In this paper we present a new cognitive behavioural formulation of the maintenance of anorexia nervosa. We have chosen this perspective since cognitive behavioural accounts of the maintenance of other psychiatric disorders have led to important advances in treatment (see Clark and Fairburn, 1997). For example, this has been true of depression (Beck et al., 1979; Craighead et al., 1998), panic disorder (Clark, 1986; Barlow et al., 1998) and, most notably in this context, bulimia nervosa (Fairburn, 1981; Wilson and Fairburn, 1998).