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Using an OCD formulation in the treatment of anorexia nervosa: a useful way to understand the illness?

Published online by Cambridge University Press:  06 September 2013

Paul E. Jenkins
Paul E. Jenkins*
Affiliation:
Oxford Health NHS Foundation Trust, Oxford, UK School of Psychology, University of Birmingham, UK
*
*Address for correspondence: Dr P. E. Jenkins, Cotswold House Eating Disorders Service, Warneford Hospital, Warneford Lane, Headington, Oxford OX3 7JX, UK (email: pej106@gmail.com).
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Abstract

Anorexia nervosa (AN) and obsessive compulsive disorder (OCD) have been shown to have a number of commonalities, such as genetics, neurobiology, and symptoms. Approaches to treatment of AN have recently been described that take such findings into account, extending interventions recommended for obsessive compulsive and anxiety disorders to AN. The current paper aims to outline a formulation model of AN in adults, derived from the literature on OCD, and introduce this topic as a fruitful area to build on existing treatment techniques, and to prompt further discussion of such techniques. A formulation model is described, followed by a discussion of how this might be applied to AN, using examples from clinical practice. Potential benefits and difficulties are discussed. A formulation model is suggested that can easily be adapted to AN, complementing existing models in eating disorders.

Keywords

Anorexia nervosaformulationobsessive compulsive disordertherapy
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 6 , 2013 , e8
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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References

Recommended follow-up reading

Pallister, E, Waller, G (2008). Anxiety in the eating disorders: understanding the overlap. Clinical Psychology Review 28, 366–386.Google Scholar
Steinglass, J, Sysko, R, Glasofer, D, Albano, AM, Simpson, HB, Walsh, BT (2011). Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. International Journal of Eating Disorders 44, 134–141.CrossRefGoogle Scholar

References

Abramowitz, JS, Whiteside, S, Lynam, D, Kalsy, S (2001). Is thought-action fusion specific to obsessive-compulsive disorder?: a mediating role of negative affect. Behaviour Research and Therapy 41, 1069–1079.Google Scholar
Altman, SE, Shankman, SA (2009). What is the association between obsessive-compulsive disorder and eating disorders? Clinical Psychology Review 29, 638–646.Google Scholar
Aspen, V, Darcy, AM, Lock, J (2013). A review of attention biases in women with eating disorders. Cognition & Emotion 27, 820–838.Google Scholar
Bieling, PJ, Kuyken, W (2003). Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice 10, 52–69.Google Scholar
Coelho, J, Baeyens, C, Purdon, C, Pitet, A, Bouvard, M (2012). Cognitive distortions and eating pathology: specificity of thought-shape fusion. Behaviour Research and Therapy 50, 449–456.Google Scholar
Cooper, M, Todd, G, Wells, A (2009). Treating Bulimia Nervosa and Binge Eating: An Integrated Metacognitive and Cognitive Therapy Manual. Hove, UK: Routledge.Google Scholar
Davis, C, Kaptein, S (2006). Anorexia nervosa with excessive exercise: a phenotype with close links to obsessive-compulsive disorder. Psychiatry Research 142, 209–217.Google Scholar
Deacon, B, Maack, DJ (2008). The effects of safety behaviors on the fear of contamination: an experimental investigation. Behaviour Research and Therapy 46, 537–547.Google Scholar
Enoch, M-A, Kaye, WH, Rotondo, A, Greenberg, BD, Murphy, DL, Goldman, D (1998). 5-HT2A promoter polymorphism -1438G/A, anorexia nervosa, and obsessive-compulsive disorder. Lancet 351, 1785–1786.Google Scholar
Fairburn, CG (2008). Cognitive Behaviour Therapy and Eating Disorders. New York: Guilford Press.Google Scholar
Fairburn, CG, Cooper, Z, Doll, HA, O'Connor, ME, Palmer, RL, Dalle Grave, R (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK–Italy study. Behaviour Research and Therapy 51, R2–8.Google Scholar
Friederich, H-C, Herzog, W (2011). Cognitive-behavioral flexibility in anorexia nervosa. Current Topics in Behavioral Neurosciences 6, 111–124.CrossRefGoogle ScholarPubMed
Hildebrandt, T, Bacow, T, Markella, M, Loeb, KL (2012). Anxiety in anorexia nervosa and its management using family-based treatment. European Eating Disorders Review 20, e1–16.Google Scholar
Holden, NL (1990). Is anorexia nervosa an obsessive-compulsive disorder? British Journal of Psychiatry 157, 1–5.Google Scholar
Jansen, A, Nederkoorn, C, Mulkens, S (2005). Selective visual attention for ugly and beautiful body parts in eating disorders. Behaviour Research and Therapy 43, 183–196.CrossRefGoogle ScholarPubMed
Kaplan, AS, Garfinkel, PE (1999). Difficulties in treating patients with eating disorders: a review of patient and clinician variables. Canadian Journal of Psychiatry 44, 665–670.Google Scholar
Kostopoulou, M, Varsou, E, Stalikas, A (2011). Thought-shape fusion in bulimia nervosa: an experimental investigation. Eating and Weight Disorders 16, e86–92.Google Scholar
Lavender, A, Schmidt, U (2006). Cognitive-behavioural case formulation in complex eating disorders. In Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases (ed. Tarrier, N.), pp. 238–262. Hove, UK: Routledge.Google Scholar
Lavender, A, Shubert, I, de Silva, P, Treasure, J (2006). Obsessive-compulsive beliefs and magical ideation in eating disorders. British Journal of Clinical Psychology 45, 331–342.Google Scholar
May, J, Andrade, J, Batey, H, Berry, L-M, Kavanagh, DJ (2010). Less food for thought. Impact of attentional instructions on intrusive thoughts about snack foods. Appetite 55, 279–287.Google Scholar
Milos, G, Spindler, A, Ruggiero, G, Klaghofer, R, Schnyder, U (2002). Comorbidity of obsessive-compulsive disorders and duration of eating disorders. International Journal of Eating Disorders 31, 284–289.Google Scholar
Naylor, H, Mountford, V, Brown, G (2011). Beliefs about excessive exercise in eating disorders: the role of obsessions and compulsions. European Eating Disorders Review 19, 226–236.Google Scholar
Overholser, JC (2011). Collaborative empiricism, guided discovery, and the Socratic method: core processes for effective cognitive therapy. Clinical Psychology: Science and Practice 18, 62–66.Google Scholar
Pallister, E, Waller, G (2008). Anxiety in the eating disorders: understanding the overlap. Clinical Psychology Review 28, 366–386.Google Scholar
Persons, JB (2006). Case formulation-driven psychotherapy. Clinical Psychology: Science and Practice 13, 167–170.Google Scholar
Persons, JB, Tompkins, MA (2007). Cognitive-behavioral case formulation. In Handbook of Psychotherapy Case Formulation, 2nd edn (ed. Eells, T. D.), pp. 290–316. New York: Guilford Press.Google Scholar
Placanica, JL, Faunce, GJ, Soames Job, RF (2002). The effect of fasting on attentional biases for food and body shape/weight words in high and low Eating Disorder Inventory scorers. International Journal of Eating Disorders 32, 79–90.Google Scholar
Rachman, S, de Silva, P (1978). Abnormal and normal obsessions. Behaviour Research and Therapy 16, 233–248.Google Scholar
Radomsky, AS, de Silva, P, Todd, G, Treasure, J, Murphy, T (2002). Thought-shape fusion in anorexia nervosa: an experimental investigation. Behaviour Research and Therapy 40, 1169–1177.Google Scholar
Rawal, A, Park, RJ, Williams, JMG (2010). Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behaviour Research and Therapy 48, 851–859.Google Scholar
Roncero, M, Perpiñá, C, García-Soriano, G (2011). Study of obsessive compulsive beliefs: relationship with eating disorders. Behavioural and Cognitive Psychotherapy 39, 457–470.CrossRefGoogle ScholarPubMed
Salkovskis, PM (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy 19, 6–19.Google Scholar
Salkovskis, PM (2007). Psychological treatment of obsessive-compulsive disorder. Psychiatry 6, 229–233.Google Scholar
Salkovskis, PM, Campbell, P (1994). Thought suppression induces intrusion in naturally occurring negative intrusive thoughts. Behaviour Research and Therapy 32, 1–8.Google Scholar
Salkovskis, PM, Wahl, K (2004). Treating obsessional problems using cognitive-behavioral therapy. In Cognitive Therapy Across the Lifespan: Evidence and Practice (ed. Reinecke, M. A. and Clark, D. A.), pp. 138–171. Cambridge, UK: Cambridge University Press.Google Scholar
Serpell, L, Livingstone, A, Neiderman, M, Lask, B (2002). Anorexia nervosa: obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither? Clinical Psychology Review 22, 647–669.Google Scholar
Shafran, R (2002). Eating disorders and obsessive compulsive disorder. In Cognitive Approaches to Obsessions and Compulsions: Theory, Assessment, and Treatment (ed. Frost, R. O. and Steketee, G.), pp. 215–231. Oxford, UK: Elsevier Science.Google Scholar
Shafran, R, Robinson, P (2004). Thought-shape fusion in eating disorders. British Journal of Clinical Psychology 43, 399–407.Google Scholar
Shafran, R, Teachman, BA, Kerry, S, Rachman, S (1999). A cognitive distortion associated with eating disorders: thought-shape fusion. British Journal of Clinical Psychology 38, 167–179.Google Scholar
Sloan, T, Telch, MJ (2002). The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: an experimental investigation. Behaviour Research and Therapy 40, 235–251.CrossRefGoogle ScholarPubMed
Soetens, B, Braet, C (2006). ‘The weight of a thought’: food-related thought suppression in obese and normal-weight youngsters. Appetite 46, 309–317.Google Scholar
Soetens, B, Braet, C, Dejonckheere, P, Roets, A (2006). ‘When suppression backfires’: the ironic effects of suppressing eating-related thoughts. Journal of Health Psychology 11, 655–668.Google Scholar
Spranca, M, Minsk, E, Baron, J (1991). Omission and commission in judgement and choice. Journal of Experimental Social Psychology 27, 76–105.CrossRefGoogle Scholar
Steinglass, J, Albano, AM, Simpson, B, Carpenter, K, Schebendach, J, Attia, E (2012). Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series. International Journal of Eating Disorders 45, 615–621.Google Scholar
Steinglass, J, Sysko, R, Glasofer, D, Albano, AM, Simpson, HB, Walsh, BT (2011). Rationale for the application of Exposure and Response Prevention to the treatment of anorexia nervosa. International Journal of Eating Disorders 44, 134–141.Google Scholar
Steinglass, J, Sysko, R, Mayer, L, Berner, LA, Schebendach, J, Wang, Y, Chen, H, Albano, AM, Simpson, HB, Walsh, BT (2010). Pre-meal anxiety and food intake in anorexia nervosa. Appetite 55, 214–218.Google Scholar
Steinglass, J, Walsh, BT (2006). Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis. International Journal of Eating Disorders 39, 267–275.Google Scholar
Steinhausen, H-C (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry 159, 1284–1293.Google Scholar
Stewart, A (2005). Disorders of eating control. In Cognitive Behaviour Therapy for Children and Families (ed. Graham, P.), pp. 359–384. Cambridge, UK: Cambridge University Press.Google Scholar
Stice, E (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin 128, 825–848.Google Scholar
Strober, M, Freeman, R, Lampert, C, Diamond, J (2007). The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: evidence from a family study with discussion of nosological and neurological evidence. International Journal of Eating Disorders 40, S46–51.Google Scholar
Sunday, SR, Halmi, KA, Einhorn, A (1995). The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology. International Journal of Eating Disorders 18, 237–245.3.0.CO;2-1>CrossRefGoogle Scholar
Swinbourne, JM, Touyz, SW (2007). The co-morbidity of eating disorders and anxiety disorders. European Eating Disorders Review 15, 253–274.Google Scholar
Tchanturia, K, Hambrook, D (2010). Cognitive remediation therapy for anorexia nervosa. In: The Treatment of Eating Disorders: A Clinical Handbook (ed. Grilo, C. M. and Mitchell, J. E.), pp. 130–149. New York, NY: Guilford Press.Google Scholar
Veale, D (2007). Psychopathology of obsessive-compulsive disorder. Psychiatry 6, 225–228.CrossRefGoogle Scholar
Vitousek, K, Ewald, LS (1993). Self-representation in eating disorders: a cognitive perspective. In The Self in Emotional Distress: Cognitive and Psychodynamic Perspectives (ed. Segal, Z. V. and Blatt, S. J.), pp. 221–257. New York, NY: Guilford Press.Google Scholar
Vitousek, K, Watson, S, Wilson, GT (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review 18, 391–420.CrossRefGoogle ScholarPubMed
Waller, G (2008). A ‘trans-transdiagnostic’ model of the eating disorders: a new way to open the egg? European Eating Disorders Review 16, 165–172.Google Scholar
Waller, G, Cordery, H, Corstorphine, E, Hinrichsen, H, Lawson, R, Mountford, V, Russell, K (2007). Cognitive Behavioral Therapy for Eating Disorders: A Comprehensive Treatment Guide. New York: Cambridge University Press.Google Scholar
Waller, G, Ohanian, V, Meyer, C, Osman, S (2000). Cognitive content among bulimic women: the role of core beliefs. International Journal of Eating Disorders 28, 235–241.Google Scholar
Whitaker, A, Davies, M, Shaffer, D, Johnson, J, Abrams, S, Walsh, BT, Kalikow, K (1989). The struggle to be thin: a survey of anorexic and bulimic symptoms in a non-referred adolescent population. Psychological Medicine 19, 143–163.Google Scholar
Wildes, JE, Marcus, MD (2011). Development of emotion acceptance behaviour therapy for anorexia nervosa: a case series. International Journal of Eating Disorders 44, 421–427.Google Scholar
Williamson, DA, Muller, SL, Reas, DL, Thaw, JM (1999). Cognitive bias in eating disorders: implications for theory and treatment. Behavior Modification 23, 556–577.Google Scholar
Yager, J (1992). Patients with chronic, recalcitrant eating disorders. In Special Problems in Managing Eating Disorders (ed. Yager, J., Gwirtsman, H. E. and Edelstein, C. E.), pp. 205–237. Washington, DC: APA Press.Google Scholar
Zubieta, JK, Demitrack, MA, Fenick, A, Krahn, DD (1995). Obsessionality in eating-disorder patients: relationship to clinical presentation and two-year outcome. Journal of Psychiatric Research 4, 333–342.Google Scholar
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