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Psychotherapy for Anorexia Nervosa

Meghan Medlock

What is anorexia?

Anorexia nervosa is an eating disorder that consists of self-regulated food restriction in which the person strives for thinness and also involves distortion of the way the person sees his or her own body. An anorexic person weighs less than 85% of their ideal body weight. The prevalence of eating disorders is between .5-1% of women aged 15-40 and about 1/20 of this number occurs in men. Anorexia affects all aspects of an affected person's life including emotional health, physical health, and relationships with others (Shekter-Wolfson et al 5-6). A study completed in 1996 showed that anorexics also tend to possess traits that are obsessive in nature and carry heavy emotional reliance on other people (Herpertz-Dahlmann et al 461). Dependency, self-directed hostility, and assertiveness did not correlate highly with anorexia nervosa as assumed (Rogers and Petrie 138). In addition, anorexics tend to require constant hospitalization which incur personal and systematic costs (Shekter-Wolfson et al 6-7).

Methods of Clinical Assessment

In order for a person to be diagnosed with anorexia nervosa, they must possess the two essential psychological symptoms of the drive for thinness and the body image distortion problem. According to the DSM-IV, anorexics are categorized into two categories, restricting and binge-eating/purging types. Another assessment device is the Eating Attitudes Test and the Eating Disorders Inventory. The evaluation of an affected person should be multidimensional and comprehensive because of the severity of this problem (Shekter-Wolfson et al 10).

After this has taken place, a formal interview with the client is conducted. This interview consists of many components. The history of the client's weight is assessed as well as the extent to which he or she is immersed with the ideas of body weight and shape. If the counselor possesses a firm, understanding perspective, the client will more likely open up and share issues with the advisor. As long as the interviewer knows that the symptoms expressed by the client are due to the eating disorder itself (in this case starvation), the counselor can grasp the problem in a tight manner. Other issues discussed between the interviewer and the client include past history of emotional disturbance, past medical history, family history, current family situation, family eating patterns, family attitudes about weight, and other personal history. Another important criterion that must be addressed is the presence or absence of past or present physical or sexual abuse because this is a significant determinant of a person possessing an eating disorder (Shekter-Wolfson et al 13).


The first step in the treatment of anorexia is to aid the client in adapting a more standardized eating pattern. A dietitian may intervene at this point to assist the affected person to adopt more healthy eating behaviors. The counselor's role is to gradually help the client begin to adopt a more normal eating style (Shekter-Wolfson et al 13). In all cases, however, there are six goals of any treatment process:

1) To treat the medical complications

2) To revive a normal state of eating

3) To provide guidance on nutrition and exercise

4) To alter distorted views through CBT

5) To optimize support by educating the family

6) To enhance self-esteem with or without medication (Anonymous 101)

Cognitive Behavior Therapy

The most common form of outpatient individual therapy is cognitive behavioral therapy (CBT). This type of therapy focuses on the thoughts that envelop food and eating and presents a challenge to the dysfunctional beliefs on the part of the anorexic. One of the main goals of CBT is for the affected person to acquire a more self-focused and self-observant approach, so the person is asked to keep a diary of food intake and a journal of thought processes during the treatment period. There is still much more work to be done to assess whether CBT is as or more effective than other treatments of anorexia nervosa (Shekter-Wolfson et al 15).

Interpersonal therapy is an broadened form of psychotherapy in which the focus is upon the patient's relationships with others and with the therapist (Shekter-Wolfson et al 15). Many psychologists believe that many anorexic people also face shortages in psychosocial functioning may also be a factor in the lengthiness of an anorexic's condition. More research is needed to assess whether new and improved elements should be added to the treatment agenda, but the sense is that programs on sexuality or an interpersonal approach should be added to the CBT method (Herpertz-Dahlmann et al 454).

Almost every type of psychotherapy has been used on anorexic patients and all have been proven to be effective (Yager 156). However, more structured and organized forms of psychotherapies, including behavioral therapy, tend to work more effectively early on in the treatment process while more psychodynamic treatments like behavioral or family therapy are used more gradually for a period of one to two years. A longitudinal study was conducted with 24 anorexic patients who were continuously receiving inpatient treatment. A comprehensive behavior therapy process lead to a significant improvement in body weight, eating habits, and body image and these results remained for 7 years when the follow-up was conducted. At the 7 year point, most of the patients had improved more so than at the one year point (Yager 158).

In cognitive behavior therapy for anorexia, the disorder is treated as if anorexia is nothing more than a fight for freedom, intelligence, self-respect, and self-discipline. Another goal of CBT is to correct the unhealthy cognitive processes that are causing the distorted beliefs. Even though most of these techniques are not used during periods of emaciation where the main goal is for the patient to regain weight, many people consider psychodynamic psychotherapies and cognitive treatment to be the most advantageous interventions for aiding the patients in keeping the weight on their bodies as well as to ease psychological maturation and improvement. There are six cognitive approaches that are widely used in CBT:

1) education about the disorder

2) providing informational answers to questions in regard to weight, calorie intake, and changing health status

3) showing the patient to recognize and focus upon negative thoughts and other emotions linked to the distorted beliefs and fixations associated with weight, body shape, nutrition, exercise, and other aspects of the disorder.

4) teaching the patient to come up with and replace alternative, more productive and positive thoughts for the negative ones

5) problem-solving discussions

6) teaching alternative coping strategies (Yager 160-161)

Family Therapy

As a result of a study conducted by Russell et al in 1987, family therapy was shown to be highly effective and necessary in most cases, especially in cases where the patient is still living at home. The reason is because anorexia creates high emotional stress that echoes among all family members. Families in which there is a lot of 'expressed emotion' (families that express large amounts of negative and critical attitudes) adversely affect the progress of an anorexic patient. Families undergoing a large amount of stressors may benefit from behavioral therapy techniques in which the patient and the family together learn communication and problem-solving skills. In severe cases where there is dysfunctional interactions occurring, 'constructive separations of family members are implemented. Also, family support groups with more than one family discussing problems together can help families face realistic goals about their individual cases (Yager 163). One study conducted on family therapy showed a more effective outcome for younger clients as opposed to individual therapy (Shekter-Wolfson et al 18). At any rate, family therapy will differ in nature and content depending on the family situation at hand (White 94).


I think that CBT is the most effective form of treatment for anorexia. My reasons are that if the patient can alter his/her thoughts permanently, true changes in cognitions could take place. I have many friends who have this terrible eating problem and I have strongly recommended this form of treatment to them after doing the research for this paper.

Works Cited

Anonymous (1995). Treatment Options for Eating Disorders. Patient Care. 29: 101-105.

Herpertz-Dahlmann, B., Wewetzer, C., Hennighausen, K., and Remschmidt, H. (1996). Outcome, Psychosocial Functioning, and Prognostic Factors in Adolescent Anorexia Nervosa as Determined by Prospective Follow-up Assessment. Journal of Youth and Adolescence. 25: 455-465.

Rogers, Rebecca L., and Petrie, Trent A. (1996). Personality Correlates of Anorexic Symptomatology in Female Undergraduates. Journal of Counseling and Development. 75: 138-141.

Shekter-Wolfson, Lorie F., Woodside, D. Blake, and Lackstrom, Jan D. (1997). Social Work Treatment of Anorexia and Bulimia: Guidelines for Practice. Research on Social Work Practice. 7: 5-20.

White, Mark B. (1997). How Good is Family Therapy? A Reassessment. Journal of Marital and Family Therapy. 23: 93-94.

Yager, Joel (1994). Psychosocial Treatments for Eating Disorders. Psychiatry. 57: 153-168.


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