2011 Volume 23 Issue 4 Pages 355-363
The psychopathology of eating disorders has been rapidly changing and expanding since introduction of bulimia nervosa as an ominous variant of anorexia nervosa, three decades ago. The efficacy of cognitive-behavioral therapy for bulimia nervosa (CBT-BN) was first reported by Fairburn et al. (1981). Most guidelines now recommend CBT-BN as a first choice of treatment for bulimia nervosa. Because of the increasing complexity of psychopathology, CBT-enhanced (CBT-E) therapy that addresses mood intolerance, clinical perfectionism, low self-esteem, and interpersonal difficulties in addition to the eating disorder symptoms themselves is being newly proposed. The initial report regarding the efficacy of CBT-E appears to be promising (Fairburn et al. 2009); however eating disorder patients currently being treated at our facility have a considerably greater number of comorbid disorders such as generalized social anxiety disorders, avoidant personality disorders, and multi-impulsivity disorders. For these patients, more specific treatment such as CBT for social anxiety disorder or dialectical behavior therapy should be considered.
