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Anorexia nervosa (AN) is a severe mental disorder that affects mainly young females. In adults with a well-established form of the illness, it is hard to treat. In 2006, we proposed a maintenance model of AN, combining intra- and interpersonal factors and we have recently refined this model. The model encompasses four main maintaining factors (a thinking style characterized by rigidity, detail focus, and a fear of making mistakes; an avoidant emotion processing and relational style; positive beliefs about the use of anorexia for the person [pro-anorexia beliefs]; and a response of close others to the illness characterized by high expressed emotion and enabling of and accommodation to the illness). In this article, we describe how the model has been translated into a novel treatment for AN and the preliminary evidence supporting this. Implications for clinical practice and research are discussed.
Keywords: eating disorders; anorexia nervosa; psychological therapy; MANTRA
Anorexia nervosa (AN) is a perplexing disorder for the clinician. Patients often present as blank-faced, reserved, and stoical with little emotional expression. Alternatively, they appear inexplicably cheerful, telling the clinician that everything is fine, that they do not have any problems, and that everyone around them worries unnecessarily. History taking takes little time and reveals little of note. This enigmatic and bland psychological presentation sharply contrasts with the emaciated, perhaps even skeletal, physical appearance of the person. It also contrasts with the intense distress and frustration of families and close others who are terrified that their loved one will come to serious harm or may die.
Key symptoms of AN include a relentless pursuit of thinness and overvaluation of emaciation in combination with and driven by an extreme dread of food, eating, and normal body weight (Koskina, Campbell, & Schmidt, 2013). Often, the only time a person with AN will show distress or anger is if asked to eat.
Indeed, AN is a life-threatening illness, with a mortality rate twice that of other psychiatric disorders, a suicide rate 200 times that of the general population, and high levels of disability and psychological and physical comorbidity (Guillaume et al., 2011; Treasure, Claudino, & Zucker, 2010). The costs to the individual, their families, and society are high (Kyriacou, Treasure, & Schmidt, 2008b; Simon, Schmidt, & Pilling,...