Developing a model of the treatment for eating disorder: Using neuroscience research to examine the how rather than the what of change

Abstract

Treatments for eating disorders, in particular for people with anorexia nervosa, have often been adaptations of therapies designed for other conditions. Indeed, there is a move advocating the use of a transdiagnostic treatment approach in which general module based treatments are mixed together as needed rather than using a specific anorexia nervosa targeted strategy. The outcome of treatment is relatively poor, especially for those who for some reason do not have the benefit of an expert form of early intervention for anorexia nervosa. Technological advances in the neurosciences and genetics have radically altered how eating disorders and in particular anorexia nervosa have been conceptualised. In this paper we describe evidence that suggests that key aspects of the social information processing network both the cognitive and affective elements may be anomalous in people with anorexia nervosa. This has implications for models of treatment which can be tailored more directly to these causal and or maintaining factors. We describe the Maudsley method of working with adults with anorexia nervosa which has integrated these elements. This treatment approach includes working with the individual to develop a more flexible and holistic cognitive style with greater emotional intelligence. This is supplemented with work with the families to interrupt interactions that either accommodate to or aggravate the symptoms. Thus we are now in the position to understand and work to change how people with anorexia nervosa think and behave rather than focusing on what people think and say they do. Our prediction is that treatments that focus more directly on aetiology such as the intrapersonal and interpersonal maintaining factors will improve outcome.

Keywords:

• Treatment approach
• neuroscience
• eating disorders
• anorexia nervosa
• cognition
• flexibility
• family
• expressed emotion