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Cognitive Therapy and Research

, Volume 29, Issue 6, pp 717–732 | Cite as

The Role of Schema Processes in the Eating Disorders

  • Amy Luck
  • Glenn Waller
  • Caroline Meyer
  • Michael Ussher
  • Hubert Lacey
Article

Abstract

This study tested a new schema-based cognitive-behavioural model of eating disorders. The model is predicated on the assumption that important differences between bulimic and restrictive psychopathology exist at the level of schema processing. To test this model, 134 females with eating disorders and 345 non-eating disordered females were recruited. Factor analyses validated the measures used. Three factors emerged for primary avoidance of affect (strategies to avoid the activation of emotion), and two for secondary avoidance of affect (strategies to reduce the experience of emotion once it has been triggered). As predicted, primary and secondary avoidance of affect were found in anorexia, where anorexics of the binge/purge subtype displayed the highest levels. In contrast, secondary avoidance of affect was found to characterise bulimia nervosa, and this avoidance was confined to the behavioural/somatic domain. These findings cannot be explained by existing models of eating disorders, but offer some support for the proposed schema-based model. Treatment implications are discussed, and it is suggested that cognitive-behavioural treatments might be extended to address schema processes in order to help those who suffer from eating-disorders to change their behaviours.

Key Words

Anorexia bulimia schema processes affect 

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References

  1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.Google Scholar
  2. Beumont, P. J., Kopec-Schrader, E. M., Talbot, P., & Touyz, S. W. (1993). Measuring the specific psychopathology of eating disorder patients. Australian and New Zealand Journal of Psychiatry, 27, 506–511.PubMedGoogle Scholar
  3. Beck, A. T. (1996). Beyond belief: A theory of modes, personality and psychopathology. In P. M. Salkovskis (Ed.) Frontiers of cognitive therapy (pp. 1–25). New York: Guilford.Google Scholar
  4. Brewerton, T. D., Hand, L. D., & Bishop, E. R. (1993). The Tridimensional Personality Questionnaire in eating disorder patients. International Journal of Eating Disorders, 14, 213–218.PubMedGoogle Scholar
  5. Bruch, H. (1973). Eating disorders: Obesity, anorexia and the person within. New York: Basic Books.Google Scholar
  6. Bulik, C. M., Sullivan, P. F., Fear, J. L., & Joyce, P. R. (1997). Eating disorders and antecedent anxiety disorders: A controlled study. Acta Psychiatricia Scandinavica, 96, 101–107.Google Scholar
  7. Casper, R. C., Hedeker, D., & McClough, J. F. (1992). Personality dimensions in eating disorders and their subtyping. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 830–840.PubMedGoogle Scholar
  8. Clark, D. A., Feldman, J., & Channon, S. (1989). Dysfunctional thinking in anorexia and bulimia nervosa. Cognitive Therapy and Research, 13, 377–387.CrossRefGoogle Scholar
  9. Cooper, M. J. (1997). Cognitive theory in anorexia nervosa and bulimia nervosa: A review. Behavioural and Cognitive Psychotherapy, 25, 113–145.CrossRefGoogle Scholar
  10. Cooper, M., Todd, G., & Wells, A. (1998). Content, origins, and consequences of dysfunctional beliefs in anorexia nervosa and bulimia nervosa. Journal of Cognitive Psychotherapy: An International Quarterly, 12, 213–230.Google Scholar
  11. Cooper, M., Wells, A., Todd, G. (2004). A cognitive model of bulimia nervosa. British Journal of Clinical Psychology, 43, 1–16.PubMedCrossRefGoogle Scholar
  12. Fahy, T., & Eisler, I. (1993). Impulsivity and eating disorders. British Journal of Psychiatry, 162, 193–197.PubMedCrossRefGoogle Scholar
  13. Fairburn, C. G. (1997). Eating disorders. In D. M. Clark, & C. G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy (pp. 209–238). Oxford: Oxford University Press.Google Scholar
  14. Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.PubMedCrossRefGoogle Scholar
  15. Fairburn, C. G., Shafran, R., & Cooper, Z. (1999). A cognitive behavioural theory of anorexia nervosa. Behaviour Research and Therapy, 37, 1–13.PubMedCrossRefGoogle Scholar
  16. Garner, D., & Bemis, K. M. (1982). A cognitive-behavioural approach to anorexia nervosa. Cognitive Therapy and Research, 6, 123–150.CrossRefGoogle Scholar
  17. Geller, J., Cockell, S. J., & Goldner, E. M. (2000). Inhibited expression of negative emotions and interpersonal orientation in anorexia nervosa. International Journal of Eating Disorders, 28, 8–19.PubMedCrossRefGoogle Scholar
  18. Heatherton, T. F., & Baumeister, R. F. (1991). Binge-eating as an escape from awareness. Psychological Bulletin, 110, 86–108.PubMedCrossRefGoogle Scholar
  19. Herzog, D. B., Keller, M. B., Lavori, P. W., Kenny, G. M., & Sacks, N. R. (1992). The prevalence of personality disorders in 210 women with eating disorders. Journal of Clinical Psychiatry, 53, 147–152.PubMedGoogle Scholar
  20. Howard, G. S. (1990). On the construct validity of self-reports: What do the data say? American Psychologist, 45, 292–294.Google Scholar
  21. Kline, P., & Cooper, C. (1984). A construct validation of the objective analytic test battery (OATB). Personality and Individual Differences, 5, 323–338.CrossRefGoogle Scholar
  22. Lacey, J. H. (1986). Pathogenesis. In L. J. Downey, & J. C. Malkin (Eds.), Current approaches: Bulimia nervosa (pp. 17–26). Southampton: Duphar.Google Scholar
  23. Lacey, J. H., & Evans, D. H. (1986). The impulsivist: A multi-impulsive personality disorder. British Journal of Addiction, 81, 641–649.PubMedCrossRefGoogle Scholar
  24. Leung, N., Waller, G., & Thomas, G. V. (1999). Core beliefs in anorexic and bulimic women. Journal of Nervous and Mental Disease, 187, 736–741.PubMedCrossRefGoogle Scholar
  25. Leung, N., Waller, G., & Thomas, G. (2000). Outcome of group cognitive-behaviour therapy for bulimia nervosa: The role of core beliefs. Behaviour Research and Therapy, 38, 145–156.PubMedCrossRefGoogle Scholar
  26. Millon, T. (1981). Disorders of personality. New York: Wiley.Google Scholar
  27. Padesky, C. (1994). Schema change processes in cognitive therapy. Clinical Psychology and Psychotherapy, 1, 267–278.Google Scholar
  28. Root, M. P. P., & Fallon, P. (1989). Treating the victimized bulimic. Journal of Interpersonal Violence, 4, 90–100.Google Scholar
  29. Serpell, L. E. (2000). “Anorexic thinking”: Cognitive processes in anorexia nervosa. PhD thesis, University of London.Google Scholar
  30. Shafran, R., & Mansell, W. (2001). Perfectionism and psychopathology: A review of research and treatment. Clinical Psychology Review, 21, 879–906.PubMedCrossRefGoogle Scholar
  31. Slade, P. (1982). Towards a functional analysis of anorexia nervosa and bulimia nervosa. British Journal of Clinical Psychology, 21, 167–179.PubMedGoogle Scholar
  32. Spranger, S. C., Waller, G., & Bryant-Waugh, R. (2001). Schema avoidance in bulimic and non-eating-disordered women. International Journal of Eating Disorders, 29, 302–306.PubMedCrossRefGoogle Scholar
  33. Vandereycken, W., & Pierloot, R. (1983). The significance and subclassification in anorexia nervosa: A comparative study of clinical features in 141 patients. Psychological Medicine, 13, 543–549.PubMedCrossRefGoogle Scholar
  34. Vitousek, K. B. (1996). The current status of cognitive behavioural models of anorexia nervosa and bulimia nervosa. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy (pp. 383–418). New York: Guilford.Google Scholar
  35. Vitousek, K., & Manke, F. (1994). Personality variables and disorders in anorexia nervosa and bulimia nervosa. Journal of Abnormal Psychology, 103, 137–147.PubMedCrossRefGoogle Scholar
  36. Waller, G. (submitted). A schema-based cognitive behavioural model of the aetiology and maintenance of restrictive and bulimic pathology in the eating disorders. Journal of Abnormal Psychology.Google Scholar
  37. Young, J. E. (1994). The Young-Rygh Avoidance Inventory. Available at: www.schematherapy.com/id43.htm
  38. Young, J. E. (1998). The Young Compensatory Inventory. Available at: www.schematherapy.com/id42.htm
  39. Young, J. E. (1999). Cognitive therapy for personality disorders: A schema focused approach (3rd ed.). Sarasota, FL: Professional Resource Exchange.Google Scholar
  40. Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  • Amy Luck
    • 1
    • 5
  • Glenn Waller
    • 2
  • Caroline Meyer
    • 3
  • Michael Ussher
    • 4
  • Hubert Lacey
    • 1
  1. 1.St. George’s Hospital Medical SchoolUniversity of LondonLondon
  2. 2.Outpatient Eating Disorders ServiceSouth West London and St. George’s Mental Health NHS TrustUK
  3. 3.School of MedicineUniversity of WarwickUK
  4. 4.Department of Community Health Sciences, Psychology, St. George’s Hospital Medical SchoolUniversity of LondonUK
  5. 5.School of Psychiatry and Behavioural Sciences, Academic Division of Clinical Psychology, Second floor, Education and Research CentreWythenshawe HospitalManchesterUnited Kingdom

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