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The Explanation of Eating Disorders: A Critical Analysis

Published online by Cambridge University Press:  29 April 2020

Hannah Hawkins-Elder Open the ORCID record for Hannah Hawkins-Elder [Opens in a new window]  and
Tony Ward Open the ORCID record for Tony Ward [Opens in a new window]
Hannah Hawkins-Elder*
Affiliation:
School of Psychology, Victoria University of Wellington, Wellington, New Zealand
Tony Ward
Affiliation:
School of Psychology, Victoria University of Wellington, Wellington, New Zealand
*
*Corresponding author: Hannah Hawkins-Elder, School of Psychology, Victoria University of Wellington, Wellington6012, New Zealand. Email: hannah.hawkinselder@vuw.ac.nz
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Abstract

Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.

Keywords

psychopathologyeating disorderstheoryexplanationtreatment
Type
Standard Paper
Information
Behaviour Change , Volume 37 , Issue 2 , June 2020 , pp. 93 - 110
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

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References

Agras, WS, Crow, SJ, Mitchell, JE, Halmi, KA and Bryson, S (2009). A 4-year prospective study of eating disorder NOS compared with full eating disorder syndromes. International Journal of Eating Disorders, 42, 565–570. doi:10.1002/eat.20708CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Bailer, UF and Kaye, WH (2010) Serotonin: Imaging Findings in Eating Disorders. In Adan, R and Kaye, W (eds), Behavioral Neurobiology of Eating Disorders, Vol.6. Berlin, Heidelberg: Springer.CrossRefGoogle Scholar
Bankoff, SM, Karpel, MG, Forbes, HE and Pantalone, DW (2012). A systematic review of dialectical behavior therapy for the treatment of eating disorders. Eating Disorders, 20, 196–215. doi:10.1080/10640266.2012.668478CrossRefGoogle ScholarPubMed
Berkman, ND, Lohr, KN and Bulik, CM (2007). Outcomes of eating disorders: A systematic review of the literature. International Journal of Eating Disorders, 40, 293–309. doi:10.1002/eat.20369CrossRefGoogle ScholarPubMed
Birmingham, CL, Touyz, S and Harbottle, J (2009) Are anorexia nervosa and bulimia nervosa separate disorders? Challenging the ‘transdiagnostic’ theory of eating disorders. European Eating Disorders Review 17, 2–13CrossRefGoogle ScholarPubMed
Brewerton, TD (1995). Toward a unified theory of serotonin dysregulation in eating and related disorders. Psychoneuroendocrinology, 20, 561–590. doi:10.1016/0306-4530(95)00001-5CrossRefGoogle Scholar
Brockmeyer, T, Holtforth, MG, Bents, H, Kämmerer, A, Herzog, W and Friederich, H-C (2012). Starvation and emotion regulation in anorexia nervosa. Comprehensive Psychiatry, 53, 496–501. doi:10.1016/j.comppsych.2011.09.003CrossRefGoogle ScholarPubMed
Broft, A, Berner, LA, Martinez, D and Walsh, BT (2011) Bulimia nervosa and evidence for striatal dopamine dysregulation: A conceptual review. Physiology & Behavior 104, 122–127CrossRefGoogle ScholarPubMed
Bulik, CM, Berkman, ND, Brownley, KA, Sedway, JA and Lohr, KN (2007). Anorexia nervosa treatment: A systematic review of randomized controlled trials. International Journal of Eating Disorders, 40, 310–320. doi:10.1002/eat.20367CrossRefGoogle ScholarPubMed
Burke, NL, Kaam, AM and Tanofsky-Kraff, M (2018). Interpersonal therapy for the treatment of eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Casper, RC (2006). The ‘drive for activity’ and ‘restlessness’ in anorexia nervosa: Potential pathways. Journal of Affective Disorders, 92, 99–107. doi:10.1016/j.jad.2005.12.039CrossRefGoogle ScholarPubMed
Chang, H (2017) Is pluralism compatible with scientific realism?. In Saatsi, J (ed.), The Routledge Handbook of Scientific Realism. London: Routledge.Google Scholar
Chen, EY, Yiu, A and Safer, DL (2018). Dialectical behaviour therapy and emotion-focused therapies for eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Craver, C and Kaplan, DM (in press). Are more details better? On the norms of completeness for mechanistic explanations. The British Journal for the Philosophy of Science. doi:10.1093/bjps/axy015Google Scholar
Culbert, KM, Racine, SE and Klump, KL (2015) Research review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. Journal of Child Psychology & Psychiatry 56, 1141–1164CrossRefGoogle ScholarPubMed
Davis, H and Attia, E (2017). Pharmacotherapy of eating disorders. Current Opinion in Psychiatry, 30, 452–457. doi:10.1097/YCO.0000000000000358CrossRefGoogle ScholarPubMed
Del Guidice, M (2018). Evolutionary psychopathology: A unified approach. New York, NY: Oxford University Press.CrossRefGoogle Scholar
de Oliveira, C, Colton, P, Cheng, J, Olmsted, M and Kurdyak, P (2017). The direct health care costs of eating disorders among hospitalized patients: A population-based study. International Journal of Eating Disorders, 50, 1385–1393. doi:10.1002/eat.22797CrossRefGoogle ScholarPubMed
Dwyer, DS, Horton, RY and Aamodt, EJ (2011). Role of the evolutionarily conserved starvation response in anorexia nervosa. Molecular Psychiatry, 16, 595–603. doi:10.1038/mp.2010.95CrossRefGoogle ScholarPubMed
Eddy, KT, Dorer, DJ, Franko, DL, Tahilani, K, Thompson-Brenner, H and Herzog, DB (2008). Diagnostic crossover in anorexia nervosa and bulimia nervosa: Implications for DSM-V. American Journal of Psychiatry, 165, 6. doi:10.1176/appi.ajp.2007.07060951CrossRefGoogle ScholarPubMed
Eisler, I (2005). The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. Journal of Family Therapy, 27, 104–131. doi:10.1111/j.1467-6427.2005.00303.xCrossRefGoogle Scholar
Erskine, HE, Whiteford, HA and Pike, KM (2016). The global burden of eating disorders. Current Opinion in Psychiatry, 29, 346–353. doi:10.1097/yco.0000000000000276CrossRefGoogle ScholarPubMed
Fairburn, CG (2008) Cognitive behavior therapy and eating disorders. Guilford Press.Google ScholarPubMed
Fairburn, CG, Shafran, R and Cooper, Z (1998). A cognitive behavioural theory of anorexia nervosa. Behaviour Research and Therapy, 37, 1–13. doi:10.1016/S0005-7967(98)00102-8CrossRefGoogle Scholar
Fairburn, CG, Cooper, Z and Shafran, R (2003). Cognitive behaviour therapy for eating disorders: A ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41, 509–528. doi:10.1016/S0005-7967(02)00088-8CrossRefGoogle ScholarPubMed
Farstad, SM, Mcgeown, LM and von Ranson, KM (2016) Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clinical Psychology Review 46, 91–105CrossRefGoogle Scholar
Fichter, MM and Quadflieg, N (2007). Long-term stability of eating disorder diagnoses. International Journal of Eating Disorders, 40, 6. doi:10.1002/eat.20443CrossRefGoogle ScholarPubMed
Flament, MF, Bissada, H and Spettigue, W (2012). Evidence-based pharmacotherapy of eating disorders. International Journal of Neuropsychopharmacology, 15, 189–207. doi:10.1017/S1461145711000381CrossRefGoogle ScholarPubMed
Forbush, KT, Chen, P, Hagan, KE, Chapa, DAN, Gould, SR, Eaton, NR and Krueger, RF (2018). A new approach to eating-disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care. International Journal of Eating Disorders, 51, 710–721. doi:10.1002/eat.22891CrossRefGoogle ScholarPubMed
Ford, BQ and Gross, JJ (2018). Emotion regulation: Why beliefs matter. Canadian Psychology/Psychologie Canadienne, 59, 1–14. doi:10.1037/cap0000142CrossRefGoogle Scholar
Gordon, KH, Holm-Denoma, JM, Douglas, VJ, Crosby, RD and Wonderlich, SA (2018). The classification of eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Haig, BD (2014). Investigating the psychological world: Scientific method in the behavioural sciences. Cambridge, MA: The MIT Press.CrossRefGoogle Scholar
Hawkins-Elder, H and Ward, T (2019). Theory construction in the psychopathology domain: A multiphase approach. Theory & Psychology 30, 77–98.CrossRefGoogle Scholar
Hiroi, R and Neumaier, JF (2011). Complex roles of estrogen in emotion: Sex matters. Biological Psychiatry, 70, 908–909. doi:10.1016/j.biopsych.2011.09.017CrossRefGoogle ScholarPubMed
Hooker, CA (1987). A realistic theory of science. Albany, NY: State University of New York Press.Google Scholar
Hyman, SE (2010). The diagnosis of mental disorders: The problem of reification. Annual Review of Clinical Psychology, 6, 155–179. doi:10.1146/annurev-clinpsy.3.022806.091532CrossRefGoogle Scholar
Keel, PK (2018). Epidemiology and course of eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Keel, PK and Brown, TA (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43, 195–204. doi:10.1002/eat.20810Google ScholarPubMed
Kendler, KS, Zachar, P and Craver, C (2011). What kinds of things are psychiatric disorders? Psychological Medicine, 41, 1143–1150. doi:10.1017/S0033291710001844CrossRefGoogle ScholarPubMed
Keys, A, Brožek, J, Henschel, A, Mickelsen, O and Taylor, HL (1950). The biology of human starvation. (vol. 2). Oxford, England: University of Minnesota Press.CrossRefGoogle Scholar
Khalsa, SS, Portnoff, LC, McCurdy-McKinnon, D and Feusner, JD (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5, 20. doi:10.1186/s40337-017-0145-3CrossRefGoogle ScholarPubMed
Kontis, D and Theochari, E (2012) Dopamine in anorexia nervosa: A systematic review. Behavioural Pharmacology 23, 496–515CrossRefGoogle ScholarPubMed
Le Grange, D and Rienecke, R (2018). Family therapy for eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Leibowitz, SF (1990). The role of serotonin in eating disorders. Drugs, 39, 33–48. doi:10.2165/00003495-199000393-00005CrossRefGoogle ScholarPubMed
Lilienfeld, SO and Treadway, MT (2016). Clashing diagnostic approaches: DSM-ICD versus RDoC. Annual Review of Clinical Psychology, 12, 435–463. doi:10.1146/annurev-clinpsy-021815-093122CrossRefGoogle ScholarPubMed
Linardon, J and Wade, TD (2018). How many individuals achieve symptom abstinence following psychological treatments for bulimia nervosa? A meta-analytic review. International Journal of Eating Disorders, 51, 287–294. doi:10.1002/eat.22838CrossRefGoogle ScholarPubMed
Linehan, MM (1987). Dialectical behaviour therapy for borderline personality disorder. Bulletin of the Menninger Clinic, 51, 261–276.Google ScholarPubMed
Linehan, MM and Chen, EY (2005). Dialectical behavior therapy for eating disorders. In: Freeman, A. (Ed). Encyclopedia of cognitive behavior therapy (pp. 168–171). Boston, MA: Springer.CrossRefGoogle Scholar
Lock, J and Le Grange, D (2005). Family-based treatment of eating disorders. International Journal of Eating Disorders, 37, S64–S67. doi:10.1002/eat.20122CrossRefGoogle ScholarPubMed
Martin, E, Dourish, CT, Rotshtein, P, Spetter, MS and Higgs, S (2019). Interoception and disordered eating: A systematic review. Neuroscience & Biobehavioral Reviews, 107, 166–191. doi:10.1016/j.neubiorev.2019.08.020CrossRefGoogle ScholarPubMed
McElroy, SL, Guerdjikova, AI, Mori, N and O'Melia, AM (2012). Current pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opinion on Pharmacotherapy, 13, 2015–2026. doi:10.1517/14656566.2012.721781CrossRefGoogle ScholarPubMed
McElroy, SL, Guerdjikova, AI, Mori, N and Keck, PE (2018). Pharmacotherapy for eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Mehler, PS (2018). Medical complications of anorexia nervosa and bulimia nervosa. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Minuchin, S and Fishman, HC (1979). Psychosomatic family in child psychiatry. Journal of the American Academy of Child Psychiatry, 18, 76–90.CrossRefGoogle ScholarPubMed
Minuchin, S, Baker, L, Rosman, BL, Liebman, R, Milman, L and Todd, TC (1975). A conceptual model of psychosomatic illness in children: Family organization and family therapy. Archives of General Psychiatry, 32, 1031–1038.CrossRefGoogle ScholarPubMed
Minuchin, S, Rosman, BL and Baker, L (1978). Psychosomatic families: Anorexia nervosa in context. Boston, MA: Harvard University Press.CrossRefGoogle Scholar
Murphy, D (2006). Psychiatry in the scientific image. Cambridge, MA: MIT Press.Google Scholar
Murray, SB, Quintana, DS, Loeb, KL, Griffiths, S and Le Grange, D (2018). Treatment outcomes for anorexia nervosa: A systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, preprint, 1–10. doi:10.1017/S0033291718002088Google ScholarPubMed
Newton-Smith, W (2002). A companion to the philosophy of science. Oxford: Blackwell.Google Scholar
Nielsen, K and Ward, T (2018) Towards a new conceptual framework for psychopathology: Embodiment, enactivism, and embedment. Theory & Psychology 28, 800–822CrossRefGoogle Scholar
Nielsen, K and Ward, T (2020). Phenomena complexes as targets of explanation in psychopathology: The relational analysis of phenomena (RAP) approach. Theory & Psychology, onlinefirst. doi:10.1177/0959354320906462CrossRefGoogle Scholar
Peat, CM, Berkman, ND, Lohr, KN, Brownley, KA, Bann, CM, Cullen, K, …, Bulik, CM (2017). Comparative effectiveness of treatments for binge-eating disorder: Systematic review and network meta-analysis. European Eating Disorders Review, 25, 317–328. doi:10.1002/erv.2517CrossRefGoogle ScholarPubMed
Potochnik, A (2017). Idealization and the aims of science. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
Reas, DL and Grilo, CM (2015). Pharmacological treatment of binge eating disorder: Update review and synthesis. Expert Opinion of Pharmacotherapy, 16, 1463–1478. doi:10.1517/14656566.2015.1053465CrossRefGoogle ScholarPubMed
Rieger, E, Van Buren, DJ, Bishop, M, Tanofsky-Kraff, M, Welch, R and Wilfley, DE (2010). An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): Causal pathways and treatment implications. Clinical Psychology Review, 30, 400–410. doi:10.1016/j.cpr.2010.02.001CrossRefGoogle ScholarPubMed
Russell, G, Szmukler, GI, Dare, C and Eisler, I (1987). An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 44, 1047–1056. doi:10.1001/archpsyc.1987.01800240021004CrossRefGoogle ScholarPubMed
Samnaliev, M, Noh, HL, Sonneville, KR and Austin, B (2015). The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the U.S. Medical Expenditures Panel Survey. Preventive Medicine Reports, 2, 32–34. doi:10.1016/j.pmedr.2014.12.002CrossRefGoogle ScholarPubMed
Shapiro, DL, Berkman, ND, Brownley, KA, Sedway, JA, Lohr, KN and Bulik, CM (2007). Bulimia nervosa treatment: A systematic review of randomized controlled trials. International Journal of Eating Disorders, 40, 321–336. doi:10.1002/eat.20372CrossRefGoogle ScholarPubMed
Steiger, H (2004). Eating disorders and the serotonin connection: State, trait and developmental effects. Journal of Psychiatry & Neuroscience, 29, 20–29.Google ScholarPubMed
Strober, M, Freeman, R, Lampert, C, Diamond, J and Kaye, WH (2000) Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. The American Journal of Psychiatry 157, 393–401CrossRefGoogle ScholarPubMed
Stuhldreher, N, Konnopka, A, Wild, B, Herzog, W, Zipfel, S, Löwe, B and König, H-H (2012). Cost-of-illness studies and cost-effectiveness analyses in eating disorders: A systematic review. International Journal of Eating Disorders, 45, 476–491. doi:10.1002/eat.20977CrossRefGoogle ScholarPubMed
Svaldi, J, Schmitz, F, Baur, J, Hartmann, A, Legenbauer, T, Thaler, C, …, Tuschen-Caffier, B (2018). Efficacy of psychotherapies and pharmacotherapies for bulimia nervosa. Psychological Medicine, 49, 898–910. doi:10.1017/S0033291718003525CrossRefGoogle ScholarPubMed
Swanson, SA, Crow, SJ, Le Grange, D, Swendsen, J and Merikangas, KR (2011) Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry 68, 714–723CrossRefGoogle ScholarPubMed
Tozzi, F, Thornton, LM, Klump, KL, Fichter, MM, Halmi, KA, Kaplan, AS, …, Kaye, WH (2005). Symptom fluctuation in eating disorders: Correlates of diagnostic crossover. American Journal of Psychiatry, 162, 732–740. doi:10.1176/appi.ajp.162.4.732CrossRefGoogle ScholarPubMed
Van den Eynde, F and Schmidt, U (2008). Treatment of bulimia nervosa and binge eating disorder. Psychiatry, 7, 161–166. doi:10.1016/j.mppsy.2008.02.001CrossRefGoogle Scholar
Vögele, C, Lutz, APC and Gibson, EL (2018). Mood, emotions, and eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Ward, T and Clack, S (2019). From symptoms of psychopathology to the explanation of clinical phenomena. New Ideas in Psychology, 54, 40–49. doi:10.1016/j.newideapsych.2019.01.004CrossRefGoogle Scholar
Ward, T, Hudson, SM and Bulik, CM (1993). The abstinence violation effect in bulimia nervosa. Addictive Behaviors, 18, 671–680. doi:10.1016/0306-4603(93)90020-ACrossRefGoogle ScholarPubMed
Ward, T, Polaschek, D and Beech, AR (2006). Theories of sexual offending. Sussex, England: John Wiley & Sons Ltd.Google Scholar
Watson, HJ and Bulik, CM (2013). Update on the treatment of anorexia nervosa: Review of clinical trials, practice guidelines and emerging interventions. Psychological Medicine, 43, 2477–2500. doi:10.1017/S0033291712002620CrossRefGoogle ScholarPubMed
Westwood, H, Kerr-Gaffney, J, Stahl, D and Tchanturia, K (2017). Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66–81. doi:10.1016/j.jpsychores.2017.06.007CrossRefGoogle ScholarPubMed
Whooley, O (2014) Nosological reflections: the failure of DSM-5, the emergence of RDoC, and the decontextualization of mental distress. Society and Mental Health 4(2), 92–110CrossRefGoogle Scholar
Wilson, GT (2018). Cognitive-behavioural therapy for eating disorders. In Agras, WS and Robinson, A (Eds.), The Oxford handbook of eating disorders (2nd ed.). New York, NY: Oxford University Press.Google Scholar
Zachar, P and Kendler, KS (2017). The philosophy of nosology. Annual Review of Clinical Psychology, 13, 49–71. doi:10.1146/annurev-clinpsy-032816-045020CrossRefGoogle ScholarPubMed