Thought-shape fusion in anorexia nervosa: an experimental investigation

Cognitive biases and cognitive distortions have been implicated as important factors in the development and maintenance of many disorders. The concept of thought-shape fusion (TSF) in eating disorders was developed by Shafran, Teachman, Kerry, and Rachman (British Journal of Clinical Psychology 38 (1999) 167) as a variant of thought-action fusion, described by Shafran, Thordarson and Rachman (Journal of Anxiety Disorders 10 (1996) 379). TSF occurs when thinking about eating certain types of food increases a person's estimate of their shape and/or weight, elicits a perception of moral wrongdoing, and/or makes the person feel fat. Shafran et al. (1999) examined both the psychometric and experimental properties of TSF in an undergraduate sample. This paper reports an extension of this work to a clinical group (N=20) of patients with anorexia nervosa. After completing a set of relevant questionnaires, participants were asked to think about a food which they considered extremely fattening. They were then asked to write out the sentence, "I am eating--.", inserting the name of the fattening food in the blank. After being asked to rate their anxiety, guilt, feelings about their weight, morality, etc., participants were given the opportunity to neutralize their statement in any way they chose. The majority of the participants neutralized in ways consistent with the findings of Shafran et al. (1999). The results are discussed in terms of cognitive-behavioural formulations of eating disorders, and of the influence of cognitive biases and cognitive distortions on the processing of information relevant to food, weight and shape in anorexia nervosa.     

Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa

There is a wealth of data indicating the effectiveness of cognitive behavioral therapy in the treatment of bulimia nervosa. However, the best evidence indicates a treatment success rate of 50%. The purpose of this paper is to briefly describe cognitive behavioral treatment of bulimia nervosa and to offer suggestions on how this therapy approach may be tailored to best serve the needs of individual clients. Such tailoring should ultimately lead to even greater treatment success.     

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Funciones ejecutivas y sintomatología asociada con los trastornos de la conducta alimentaria

Recent studies agree in that patients with Eating Disorders (ED) suffer from inefficiencies in Executive Functions as a consequence of the disease. In order to determine whether or not such inefficiencies make part of the endophenotype of ED—not that they result as a mere consequence of ED—69 women were evaluated: 23 diagnosed with ED, 23 with symptoms associated to ED and 23 women without any ED or risks for developing them. All participants were administered the Eating Attitude Test (EAT -40), the Interview for Diagnosis of Eating Disorders-IV (IDED -IV), the Tower of London Test and the Wisconsin Card Sorting Test. The results showed inefficiencies in executive functions—specifically in planning and cognitive flexibility for both the analogous symptoms group and the diagnosed ED group. The findings suggest that these alterations could be present prior to the establishment of the ED, and that they can actually constitute a risk factor     

进食障碍影响因素的探讨

神经性厌食症和神经性贪食症是主要的进食障碍症状。进食障碍的影响因素有社会文化因素（例如媒体和同伴的影响）、家庭因素（如困惑和冲突）、消极情绪、低自尊水平和对自身的不满及认知和生物方面的因素等。     

Peligros de la modificación de conducta en el tratamiento de la anorexia nerviosa

RESUMEN

En los últimos años se ha señalado, de forma excesiva, la eficacia de la modificación de conducta en el tratamiento de la anorexia nerviosa. Se ha supuesto, de forma errónea, que la imposición de una mejoría de la emaciación, el síntoma más llamativo, es un tratamiento adecuado para este trastorno tan grave y complejo. Los resultados que se han publicado adolecen de falta de seguimiento. En estos pacientes, este método de tratamientos les llevó a un empeoramiento de su estado. A pesar de conseguir un aumento de peso pasajero, la modificación de conducta debe considerarse como potencialmente dañina en la anorexia nerviosa. En este artículo se aporta información sobre los efectos perjudiciales de los pacientes tratados con este método. Sus historias ilustran que los métodos de modificación de conducta no son sólo peligrosos en potencia, sino en la realidad.     

Terapia de conducta en anorexia nerviosa

RESUMEN

El presente artículo, es la contestación a uno anterior (en este mismo volumen) de la Dra. Bruch. Se contesta a las críticas realizadas contra la Terapia de conducta como procedimiento de tratamiento contra la anorexia nerviosa. Para el autor de este artículo, es cierto que los procedimientos de terapia de conducta en los casos presentados, en el anterior artículo, produjeron resultados negativos porque eran inadecuados para los problemas de cada paciente. Pero no se debería condenar este sistema cuando falla por haber sido mal utilizado, como fue en los casos relatados por la Dra. Bruch. En este artículo se analizarán estos posibles fallos.     

Emotion regulation difficulties in anorexia nervosa: Relationship to self-perceived sensory sensitivity

Changes in sensation (e.g., prickly skin) are crucial constituents of emotional experience, and the intensity of perceived changes has been linked to emotional intensity and dysregulation. The current study examined the relationship between sensory sensitivity and emotion regulation among adults with anorexia nervosa (AN), a disorder characterised by disturbance in the experience of the body. Twenty-one individuals with AN, 20 individuals with AN who were weight–restored, and 23 typical controls completed self-report measures of sensory sensitivity and emotion regulation. AN participants reported heightened sensory sensitivity and greater difficulty regulating emotions relative to controls. Self-perceived sensory sensitivity was associated with greater emotion dysregulation. Weight-restored AN participants reported greater ability to regulate emotions than their currently underweight counterparts, despite heightened sensitivity. Findings suggest that hypersensitivity may be a persisting feature in AN, and that weight restoration may involve improved ability to cope with sensation.     

Action monitoring and perfectionism in anorexia nervosa

To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP component. Questionnaire and behavioral results indicated increased perfectionism in patients with anorexia nervosa. In line with their perfectionism and controlled response style patients made significantly less errors than controls. However, when controlling for this difference in error rates, the EEG results demonstrated a reduced error-related negativity in the patient group. These seemingly contradictory outcomes of improved performance and reduced error monitoring are discussed in relation with indications of anterior cingulate cortex hypoactivity in anorexia nervosa patients.