Reference Work Entry

Handbook of Clinical Psychology Competencies

pp 1429-1460

Anorexia and Bulimia

  • David M. GarnerAffiliated withRiver Centre Clinic
  • , Christopher D. KeiperAffiliated withRiver Centre Clinic


Therapist competency is fundamental to the success in treating most psychological disorders. However, the skills required to effectively treat eating disorders may be more demanding than for many other psychological disorders because achieving competency requires familiarity with a body of scientific knowledge covering areas that are not generally a part of clinical training. Information on nutrition, dieting, biology of weight regulation, physical complications, and culture must be added to an understanding of more general psychological themes pertinent to eating disorders. Various theoretical approaches have been developed against which therapist competency can be evaluated in the treatment of eating disorders; however, this chapter describes the cognitive behavioral framework because it is the most popular and best researched. Prominent themes from the cognitive perspective include: 1) idiosyncratic beliefs related to food and weight; 2) specific reasoning errors and disturbed information processing related to the significance given to weight and shape; 3) the role of cultural ideals for feminine beauty that place a premium on dieting and weight control as a marker for self-worth; 4) positive and negative cognitive reinforcement contingencies that maintain symptoms; 5) the operation of underlying assumptions, dysfunctional self-schemas and core beliefs (e.g., low self-esteem, self-identity, perfectionism, pursuit of asceticism, need for self-control, fears of maturity, “anorexic identity,” and interoceptive deficits); and, 6) the physiological consequences of starvation that tend to aggravate pre-existing emotional disturbance and maintain disordered beliefs and behavior. The distinguishing feature of the expert clinician is the ability to identify the relevant themes and then creatively implement effective interventions that address the complex determinants of behavior. As described in this chapter, perhaps the most important element in the transition from basic to expert skills as a therapist is acquiring state-of-the-art training and supervision from a skilled and experienced therapist.