Clinical Guidance: Anorexia Nervosa Viewed as Habitual Behavior
Many patients with anorexia nervosa report that dieting helps them cope with negative affect, but once the behavior is paired with a desired outcome, it may become rewarding itself. This formulation of anorexia nervosa by Walsh (CME, p. 477) is consistent with findings that adolescent onset and shorter duration of illness are among the few factors associated with better outcome. Cognitive-behavioral therapy, interpersonal therapy, and antidepressants are ineffective, whereas interrupting the behavior and restoring normal weight are considered crucial. Younger patients often respond to family-based treatment, in which parents refeed the child to interrupt the dieting behavior. Patients with long-standing anorexia nervosa may be helped by adding habit-reversal techniques to current interventions.