Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa.

OBJECTIVE Anorexia nervosa (AN) is a life threatening and difficult to treat illness with a high relapse rate. Current treatments are inadequate and new approaches to treatment are needed. METHOD We review the data on anxiety in AN, the relationship between anxiety disorders and AN, and the use of Exposure and Response Prevention in treatment. RESULTS The overlap between AN and anxiety disorders suggest a model of AN in which baseline anxiety features yield eating related fears, avoidance behaviors, and ritualized safety behaviors that promote the underweight state and the perpetuation of the disorder. We propose an Exposure and Response Prevention treatment to prevent relapse in AN. DISCUSSION Overlap between AN and anxiety disorders suggests that Exposure and Response Prevention may be a new and beneficial approach to preventing relapse in individuals with AN.

[1]  David H. Barlow,et al.  Abnormal psychology: An integrative approach (6th ed.). , 2012 .

[2]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[3]  Abraham Weizman,et al.  An integrative quantitative model of factors influencing the course of anorexia nervosa over time. , 2009, The International journal of eating disorders.

[4]  G. Waller.  A 'trans-transdiagnostic' model of the eating disorders: a new way to open the egg? , 2008, European eating disorders review : the journal of the Eating Disorders Association.

[5]  C. Bulik,et al.  Influence of overanxious disorder of childhood on the expression of anorexia nervosa. , 2008, The International journal of eating disorders.

[6]  C. Fairburn.  Cognitive Behavior Therapy and Eating Disorders , 2008 .

[7]  Evelyn Attia,et al.  Dietary energy density and diet variety as predictors of outcome in anorexia nervosa. , 2008, The American journal of clinical nutrition.

[8]  Vijay K. Venkatraman,et al.  Altered reward processing in women recovered from anorexia nervosa. , 2007, The American journal of psychiatry.

[9]  M. Strober,et al.  The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: evidence from a family study with discussion of nosological and neurodevelopmental implications. , 2007, The International journal of eating disorders.

[10]  J. Price,et al.  Serotonin transporter binding after recovery from eating disorders , 2007, Psychopharmacology.

[11]  R. Sysko,et al.  The Application of Exposure Therapy and D-Cycloserine to the Treatment of Anorexia Nervosa: A Preliminary Trial , 2007, Journal of psychiatric practice.

[12]  T. Insel,et al.  Eating disorders: National Institute of Mental Health's perspective. , 2007, The American psychologist.

[13]  J. Price,et al.  Serotonin transporter binding after recovery from eating disorders , 2007, Psychopharmacology.

[14]  A. Klibanski,et al.  Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents. , 2006, The American journal of clinical nutrition.

[15]  C. Roberto,et al.  Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. , 2006, JAMA.

[16]  B. Walsh,et al.  Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis. , 2006, The International journal of eating disorders.

[17]  D. Thordarson,et al.  Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. , 2005, Behaviour research and therapy.

[18]  J. Silberg,et al.  The developmental association between eating disorders symptoms and symptoms of depression and anxiety in juvenile twin girls. , 2005, Journal of child psychology and psychiatry, and allied disciplines.

[19]  R. Sysko,et al.  Eating behavior among women with anorexia nervosa. , 2005, The American journal of clinical nutrition.

[20]  P. Joyce,et al.  Three psychotherapies for anorexia nervosa: a randomized, controlled trial. , 2005, The American journal of psychiatry.

[21]  C. Bulik,et al.  Comorbidity of anxiety disorders with anorexia and bulimia nervosa. , 2004, The American journal of psychiatry.

[22]  M. Strober.  Pathologic fear conditioning and anorexia nervosa: on the search for novel paradigms. , 2004, The International journal of eating disorders.

[23]  G. Wilson,et al.  Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. , 2003, The American journal of psychiatry.

[24]  Michael Davis,et al.  The role of glutamate and Gamma-Aminobutyric acid in fear extinction: clinical implications for exposure therapy , 2002, Biological Psychiatry.

[25]  H. Steinhausen.  The outcome of anorexia nervosa in the 20th century. , 2002, The American journal of psychiatry.

[26]  Per Södersten,et al.  Randomized controlled trial of a treatment for anorexia and bulimia nervosa , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[27]  Glenn Waller,et al.  Body image treatment within an inpatient program for anorexia nervosa: the role of mirror exposure in the desensitization process. , 2002, The International journal of eating disorders.

[28]  I. López-Vidriero,et al.  A one-year follow-up study in anorexia nervosa. Dietary pattern and anthropometrical evolution , 2001, European Journal of Clinical Nutrition.

[29]  A. Klibanski,et al.  Assessment of macronutrient and micronutrient intake in women with anorexia nervosa. , 2000, The International journal of eating disorders.

[30]  D. M.,et al.  Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. , 2000, The American journal of psychiatry.

[31]  K. Pike,et al.  Long-term course of anorexia nervosa: response, relapse, remission, and recovery. , 1998, Clinical psychology review.

[32]  B. Rolls,et al.  Videotape Assessment of Changes in Aberrant Meal-time Behaviors in Anorexia Nervosa After Treatment , 1998, Appetite.

[33]  B. Walsh,et al.  Does fluoxetine augment the inpatient treatment of anorexia nervosa? , 1998, The American journal of psychiatry.

[34]  K. Boutelle.  The use of exposure with response prevention in a male anorexic. , 1998, Journal of behavior therapy and experimental psychiatry.

[35]  J L Fear,et al.  Eating disorders and antecedent anxiety disorders: a controlled study , 1997, Acta psychiatrica Scandinavica.

[36]  C. Greeno,et al.  Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. , 1997, The International journal of eating disorders.

[37]  S. Nielsen,et al.  Mortality in anorexia nervosa in Denmark during the period 1970‐1987 , 1996, Acta psychiatrica Scandinavica.

[38]  K. Halmi,et al.  The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology. , 1995, The International journal of eating disorders.

[39]  C. Greeno,et al.  Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. , 1995, The American journal of psychiatry.

[40]  W. Grove,et al.  Ten-year follow-up of anorexia nervosa: clinical course and outcome , 1995, Psychological Medicine.

[41]  David H. Barlow,et al.  Abnormal Psychology: An Integrative Approach , 1994 .

[42]  P. Beumont,et al.  How Well are ‘Cured’ Anorexia Nervosa Patients? , 1993, British Journal of Psychiatry.

[43]  L. Hsu,et al.  Long-Term Mortality in Anorexia Nervosa , 1992, British Journal of Psychiatry.

[44]  K. Halmi,et al.  Relationship of perceived macronutrient and caloric content to affective cognitions about food in eating-disordered, restrained, and unrestrained subjects. , 1992, The American journal of clinical nutrition.

[45]  K. Halmi,et al.  Comorbidity of psychiatric diagnoses in anorexia nervosa. , 1991, Archives of general psychiatry.

[46]  Michael W. Otto,et al.  Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic , 1989 .

[47]  P J Cooper,et al.  The Validity of the Eating Disorder Examination and its Subscales , 1989, British Journal of Psychiatry.

[48]  L. Mynors-Wallis.  The psychological treatment of eating disorders. , 1989, British journal of hospital medicine.

[49]  S. Channon,et al.  A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa. , 1989, Behaviour research and therapy.

[50]  G. Patton.  Mortality in eating disorders , 1988, Psychological Medicine.

[51]  K. Bemis.  The Present Status of Operant Conditioning for the Treatment of Anorexia Nervosa , 1987, Behavior modification.

[52]  L. A. Goldfarb,et al.  Systematic Desensitization and Relaxation as Adjuncts in the Treatment of Anorexia Nervosa: A Preliminary Study , 1987, Psychological reports.

[53]  M. Strober.  Personality and symptomatological features in young, nonchronic anorexia nervosa patients. , 1980, Journal of psychosomatic research.

[54]  E. Foa,et al.  Differential effects of exposure and response prevention in obsessive-compulsive washers. , 1980, Journal of consulting and clinical psychology.

[55]  Paul Lavin,et al.  Post-hospitalization continuation treatment of anorexia nervosa , 1977 .

[56]  P. Slade.  A Short Anorexic Behaviour Scale , 1973, British Journal of Psychiatry.

[57]  E. A. Hallsten.  Adolescent anorexia nervosa treated by desensitization. , 1965, Behaviour research and therapy.