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

Abstract

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.

Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective

“…SUCCEAT is an intervention for caregivers of children and adolescents with AN based on the cognitive interpersonal model of maintaining factors for EDs [14][15][16] with the aim to reduce EE and burden in caregivers and improve caregiver skills. Dysfunctional communication, unhelpful reactions and emotions were addressed to increase communication skills, skills to handle difficult behavior, and strategies to encourage autonomy in patients in order to reduce EE.…”

“…The key role of interpersonal relationships, particularly, communication and high EE within the family has also been highlighted in the interpersonal maintenance model of anorexia nervosa (AN) [14][15][16]. EE was related to caregivers' distress.…”

“…SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders in Austria) is an intervention for caregivers of adolescents with AN based on the interpersonal maintenance model [14][15][16] that has already been shown to effectively reduce caregiving burden and increase caregiver skills [26]. This paper presents secondary analyses of the SUCCEAT study, focusing on various aspects of high EE.…”

Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial

“…Therefore, it is essential to teach main carers, mostly parents, specific skills and communication styles to help them handle difficult situations, in order to break the vicious circle. As confirmed by a meta-analysis of interventions for caregivers of mainly adult patients suffering from AN [9] that are based on the cognitive interpersonal model of maintaining factors for eating disorders (ED) [3,10,11], they can reduce a carer's burden and improve caregiver skills.…”

Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review

“…Data included in this review support the general conclusion that FSD in women with AN is not simply a standard consequence of emaciation or general psychopathology, but rather a problem linked to a range of, albeit currently not well understood, biopsychosocial factors that require further evaluation. The intersection of sexual function with the physiological (i.e., allostatic load), cognitive, and emotional traits underpinning AN (Treasure et al, 2020; Treasure & Schmidt, 2013) warrants further research. Future large‐scale population‐based research is required in order to estimate the prevalence of sexual dysfunction in people of all genders who are experiencing EDs or are at risk of developing eating‐related difficulties.…”