CBT: Effective Treatment for Eating Disorders?

:: Treatment for Eating Disorders ::

According to recent statistics, nearly 30 million people in the United States suffer from an eating disorder. Conventional wisdom dictates that finding a solution lies in simply addressing issues of self-control. The fact is that eating disorders are not just about weight and food.

Conditions such as anorexia, bulimia, and binge-eating are "bio-psychosocial disorders" - meaning that the root cause involves a complex array of genetic, behavioral, social, developmental and environmental factors. The co-presentation of other mental illnesses such as anxiety and depression often complicates treatment. However, recent advances point to significant progress when using an interdisciplinary approach and continuous treatment. In other words, comprehensive treatment focused on both the mind and body appears to be the most effective option.



Cognitive Behavioral Therapy (CBT) is widely recognized as the leading treatment for eating disorders. Understanding that thoughts, emotions, and behaviors are closely connected allows for systematic restructuring that can support new, healthier thoughts and actions. People who have eating disorders can struggle with a distorted view of themselves and their bodies. Chronic self-criticism can lead to feelings of shame and anxiety that become the catalyst for negative behaviors.  With the help of a qualified psychotherapist, CBT can help the individual to uncover which factors are feeding their disorder and develop practical coping skills.

Getting a handle on both cognitive Factors (negative body image, perfectionism) and behavioral factors (dietary restriction, binge-eating) allows an individual to grow in their understanding of themselves in order to facilitate healing.

Even with a majority of individuals (60%) responding positively to this type of therapy, the issue of treatment resistance remains a concern. Delving deeper into the interconnected approach has led to the development of Enhanced CBT (CBT-E) in treating eating disorders.


Enhanced CBT (CBT-E) was developed by Christopher G. Fairburn through the 1970s and 1980s. While originally intended specifically to treat bulimia, positive findings have extended its use to all eating disorders.

A 2009 CBT-E study involving 154 participants over 20 weeks of treatment and 60 weeks of follow-up compared two different types of cognitive-behavioral therapy for patients dealing with eating disorders. The first focused only on the eating disorder component while the other added treatment that addressed mood, self-esteem and interpersonal issues. Patients who received CBT-E experienced significant improvement and even maintained that improvement during the follow-up period.


The results were not affected by the type of eating disorder, and individuals who had significant struggles with mood and low self-esteem appeared to respond more favorably to the enhanced treatment that also addressed broader mental health and wellbeing. For individuals who do not have mental health conditions other than the eating disorder, the focused form of CBT that primarily deals with eating-related concerns was more effective.

A 2013 UK-Italy study focused primarily on CBT-E in the treatment of anorexia further supports the positive findings on CBT for eating disorders. Among those who completed the study, there was a "substantial, and well maintained response."

CBT-E is intended to be a structured, fixed-length treatment that occurs in four stages and is generally not intended to be used in combination with other psychological treatments. Overall, treatment is intended to develop behavioral strategies for the individual to help effectively monitor eating disorder urges, actions, and emotions. Establishment of self-monitoring is essential to the effectiveness of treatment. Implementing a solid relapse prevention strategy is another vital element in long-term recovery.

Eating disorders are among the most complex illnesses. If you or someone you know is struggling to cope with this type of condition, seeking the help of a qualified clinician is good first step. Dr. Cheryl Kornfeld in our group is an experienced clinical psychologist who specializes in eating disorders.