Eating disorders

© Cambridge University Press 2010. Eating disorders, such as anorexia nervosa and bulimia nervosa, are the source of substantial physical and psychosocial impairment among adolescent girls and young women. These disorders begin in adolescence and, once established, they are difficult to treat. The eating disorders provide one of the strongest indications for cognitive–behavioral therapy (CBT). This bold claim arises from two sources: First, the fact that eating disorders are essentially cognitive disorders; and, second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. Eating disorders are essentially cognitive disorders as they have as their distinctive core feature an overevaluation of shape and weight and their control. This overevaluation, which results in those with eating disorders judging their self-worth largely or exclusively in terms of their shape and weight and their ability to control them, is shared across anorexia nervosa and bulimia nervosa and occurs in most cases of those who fall within the DSM residual category, eating disorder not otherwise specified. In addition to being the treatment of choice for bulimia nervosa, CBT is also widely used to treat anorexia nervosa although this application has not been adequately evaluated. Recently, its use has been extended to eating disorder NOS, a diagnosis that applies to over 50% of outpatient cases, and emerging evidence suggests that it is just as effective with these cases as it is with cases of bulimia nervosa.