Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults

BMJ Open ◽

10.1136/bmjopen-2018-024185 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024185 ◽

Cited By ~ 2

Author(s):

Vicky Booth ◽

Victoria Hood-Moore ◽

Jennie E Hancox ◽

Phillipa Logan ◽

Katie R Robinson

Keyword(s):

Older Adults ◽

Scoping Review ◽

Complex Interventions ◽

Intervention Development ◽

Falls Prevention ◽

Secondary Outcome ◽

Development Framework ◽

Mrc Framework ◽

Foot Problems ◽

Study Population

ObjectivesRehabilitation interventions for older adults are complex as they involve a number of interacting components, have multiple outcomes of interest and are influenced by a number of contextual factors. The importance of rigorous intervention development prior to formal evaluation has been acknowledged and a number of frameworks have been developed. This review explored which frameworks have been used to guide the development of rehabilitation interventions for older adults.DesignSystematic scoping review.SettingStudies were not limited for inclusion based on setting.ParticipantsStudies were included that featured older adults (>65 years of age).InterventionsStudies were included that reported the development of a rehabilitation intervention.Primary and secondary outcome measuresData were extracted on study population, setting, type of intervention developed and frameworks used. The primary outcome of interest was the type of intervention development framework.ResultsThirty-five studies were included. There was a range of underlying medical conditions including mild cognitive impairment and dementia (n=5), cardiac (n=4), stroke (n=3), falls (n=3), hip fracture (n=2), diabetes (n=2), breast cancer (n=1), Parkinson’s disease (n=1), depression (n=1), chronic health problems (n=1), osteoarthritis (n=1), leg ulcer (n=1), neck pain (n=1) and foot problems (n=1). The intervention types being developed included multicomponent, support based, cognitive, physical activities, nursing led, falls prevention and occupational therapy led. Twelve studies (34%) did not report using a framework. Five frameworks were reported with the Medical Research Council (MRC) framework for developing and evaluating complex interventions being the most frequently cited (77%, n=17).ConclusionAt present, the MRC framework is the most popular for developing rehabilitation interventions for older adults. Many studies do not report using a framework. Further, specific guidance to assist this complex field of rehabilitation research is required.

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Developing mental health interventions

10.1093/med/9780199680467.003.0003 ◽

2015 ◽

Cited By ~ 1

Author(s):

Abhijit Nadkarni ◽

Mary J. De Silva ◽

Vikram Patel

Keyword(s):

Mental Health ◽

Complex Interventions ◽

Intervention Development ◽

Health Interventions ◽

Theory Of Change ◽

Complex Process ◽

Mrc Framework ◽

Mental Health Interventions ◽

Structured Approach

Most mental health interventions are complex as they are made up of a number of interconnected components, acting both independently and interdependently. This inherent complexity makes the development and evaluation of such interventions a complex process. Following a structured approach to the development and evaluation of complex interventions helps ensure that the process is systematic, rigorous, and replicable. In this chapter we demonstrate how systematically conducted formative research, consistent with the MRC framework, will ensure that due consideration is given to the sociocultural and health systems context. We use the case study of an ongoing complex intervention development and evaluation program in India (PREMIUM) to illustrate the application of the development and feasibility/piloting phases of the MRC framework. We describe two complementary frameworks, the Normalization Process Theory and the Theory of Change that can be used to strengthen the MRC framework for the development of mental health interventions.

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Faculty Opinions recommendation of Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718502443.793516520 ◽

2016 ◽

Author(s):

Glenn Waller

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Disorder Symptoms

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Pharmacotherapy for Eating Disorders

10.1093/oxfordhb/9780190620998.013.20 ◽

2017 ◽

Cited By ~ 1

Author(s):

Susan McElroy ◽

Anna I. Guerdjikova ◽

Nicole Mori ◽

Paul E. Keck

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Mental Disorders ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Night Eating Syndrome ◽

Night Eating

This chapter addresses the pharmacotherapy of the eating disorders (EDs). Many persons with EDs receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. This chapter first provides a brief rationale for using medications in the treatment of EDs. It then reviews the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES). It concludes by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.

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Epidemiology and Course of Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0003 ◽

2010 ◽

pp. 24-32 ◽

Cited By ~ 2

Author(s):

Pamela Keel

Keyword(s):

Public Health ◽

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Bulimia Nervosa ◽

The Public ◽

Purging Disorder ◽

Not Otherwise Specified ◽

Public Health Significance ◽

Health Significance

The epidemiology of eating disorders holds important clues for understanding factors that may contribute to their etiology. In addition, epidemiological findings speak to the public health significance of these deleterious syndromes. Information on course and outcome are important for clinicians to understand the prognosis associated with different disorders of eating and for treatment planning. This chapter reviews information on the epidemiology and course of anorexia nervosa, bulimia nervosa, and two forms of eating disorder not otherwise specified, binge eating disorder and purging disorder.

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Pharmacotherapy of the Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0024 ◽

2010 ◽

pp. 416-451 ◽

Cited By ~ 2

Author(s):

Susan L. McElroy ◽

Anna I. Guerdjikova ◽

Anne M. O’Melia ◽

Nicole Mori ◽

Paul E. Keck

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Mental Disorders ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Night Eating Syndrome ◽

Night Eating

Many persons with eating disorders (EDs) receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. In this chapter, we first provide a brief rationale for using medications in the treatment of EDs. We then review the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa, binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES) and sleep-related eating disorder (SRED). We conclude by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.

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Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research

Journal of Eating Disorders ◽

10.1186/s40337-021-00417-5 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ann F. Haynos ◽

Lisa M. Anderson ◽

Autumn J. Askew ◽

Michelle G. Craske ◽

Carol B. Peterson

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Anxiety Disorders ◽

Reward Processing ◽

Future Research ◽

Restrictive Eating ◽

Eating Disorder Symptoms ◽

Mood And Anxiety Disorders ◽

Reward Responsivity ◽

Eating Disorder Behaviors

AbstractAccumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.

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