Cognitive Behavior Therapy for Eating Disorders

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The criteria for a diagnosis of anorexia nervosa are summarized in Table 1. It is generally believed that fear of weight gain and body image disturbances are central features of anorexia nervosa that motivate extreme weight control methods such as fasting or purging (Williamson, 1990). The Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (DSM-IV; American Psychiatric Association, 1994) designates two subtypes of anorexia nervosa. The restricting subtype describes anorexic patients who lose weight by restrictive eating and do not binge eat or purge. The binge eating/purging subtype describes anorexic patients who binge eat and/or purge. The DSM-IV criteria for a diagnosis of bulimia nervosa are summarized in Table 2. A central feature of bulimia nervosa is binge eating in which the individual uncontrollably eats a large amount of food in a short period of time. Compensatory behaviors such as self-induced vomiting, laxative and/or diuretic abuse, compulsive exercising, or fasting are presumed to be motivated by fear of weight gain and body image disturbances (Williamson, 1990). Two subtypes of bulimia nervosa are designated in DSM-IV. The purging subtype describes persons who binge eat, but use self-induced vomiting, laxative abuse, or diuretic abuse to prevent weight gain. The nonpurging subtype describes persons who binge eat, but use other forms of compensatory behavior such as dieting or excessive exercise to prevent weight gain. It is our experience that these patients are usually 10 to 15 pounds overweight. In addition to anorexia nervosa and bulimia nervosa, DSM-IV designates a subclinical eating disorder category, eating disorder not otherwise specified (American Psychiatric Association, 1994). Examples of this diagnosis include subthreshold anorexics who are not emaciated and obese binge eaters who binge eat but do not use vomiting or exercise to prevent weight gain (Williamson, Gleaves, & Savin, 1992).