Yes, there isn't conclusive evidence to support the efficacy of CBT for Anorexia Nervosa. In general, CBT, family-based treatment, and interpersonal therapy should be considered for eating disorders.

These articles may interest you:

https://www.archivespsy.com/article/45-2/evidence-based-psychotherapy-for-treatment-of-anorexia-nervosa-in-children-and-adolescents-systematic-review/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779286/

Article The three-legged stool of evidence-based practice in eating ...

Yes, there isn't conclusive evidence to support the efficacy of CBT for Anorexia Nervosa. In general, CBT, family-based treatment, and interpersonal therapy should be considered for eating disorders.

These articles may interest you:

https://www.archivespsy.com/article/45-2/evidence-based-psychotherapy-for-treatment-of-anorexia-nervosa-in-children-and-adolescents-systematic-review/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779286/

Article The three-legged stool of evidence-based practice in eating ...

I guess you should be looking at the literature on alexithymia in therapeutic situations and in eating disorders in particular.

Good start here on the latter : Article Alexithymia in eating disorders: Systematic review and meta-...

hi stephen.

anorexia is about gaining control, CBT may not be the best approach. DBT may be better suited to this treatment? giving the patient control and letting them evaluate the good and bad may work similar to how it works for BPD patients.

how does this sound as an idea?

Yes there is some evidence. See Fairburn: CBT and eating disorders.

A structured approach is essential, based on negotiated and agreed goals and tasks, and an empathetic therapeutic relationship is vital. Looking at the antecedents is very important: trauma? Family relationships? Why does the person need this level of control? What else is the eating disorder achieving for them in their life? (Others acting parentally, showing concern?) How can they learn a new way of regulating their emotions?

I have some clinical experience w/ serious disordered eating. Along w/ AN and Bulimia I find that once nutritional status is stabilized, I find certain personality deficits need to be addressed and corrected, and find CBT to not be very useful. Psychodynamic psychotherapy is useful here. I find this to be true as well when treating folks w/ substance abuse (SUD) once they are detoxified.

Rich

Hi Sean,

Yes, DBT has been applied to some cases of AN and BN. Please see:

http://elsevierscitech.com/pdfs/CBPRA-DialectalBehaviorTherapy.pdf

Article Radically open-dialectical behavior therapy for adult anorex...

Article Adapting Dialectical Behavior Therapy For Outpatient Adult A...

You might also want to look at the research on Focal Psychodynamic Psychotherapy which approaches Anorexia from a slightly different perspective to CBT and which inlcudes the relational aspect to others in terms of expressing and managing emotions. The research evidence is quite rigorous for FPT.

Considering anorexia as a psychological problem is an assumption. It is a killer disease and not just “something neurotic” that needs to be fixed.

The latest research, mentioned somewhere in the Guardian, is that it is a brain disease, something in the brain is not working.

Many therapies have a basic assumption that the patient is doing something wrong or their thinking habits are wrong (cbt) or their feelings are wrong (psychodynamic therapy), when perhaps the problem is in their brain and has a physical cause.

What therapy could achieve, at the maximum, is help the patient find a coping strategy to help keep themselves alive. Starting from the assumption that they cannot help it that they are this way, that it is not understood, that it is not their fault the wiring is faulty, that the brain is tricking them into thinking that they don’t want or need food. That they can get help to undo the sabotage of their brain. A much more humble position taken by the therapist than unconsciously thinking that they can cure this patient.

We don’t know the cause of this disease and it could be anything. Just like delusions of grandiosity were found to be the last stages of syphilis, or that schizoprenia is not caused by “cold” mothers but as recently published is caused by a breakdown of the protection layer round braincell connections.

Hi Lilian,

you might want to look at this: Article The Media and the Chemical Imbalance Theory of Depression

It might address some of your assumptions.

There is a lot of pop psy around. imho, meds or therapy in depression is a completely different issu, not too relevant for the original question here.