An examination of factors that contribute to the development and maintenance of eating pathology

Eating disorders are characterised by serious cognitive disturbances in eating attitudes and body satisfaction. They can have dangerous consequences for the patient’s physical and psychological functioning, leading to high morbidity and mortality rates. Given that treatment recovery rates are currently between 45-60%, more research in the field of eating disorders is required. To contribute to our understanding of eating pathology, this project examined specific factors that are thought to be important in the maintenance and treatment of eating disorders by (a) examining the effectiveness of cognitive behavioural therapy for non-underweight eating disorders (CBT-ED) in reducing comorbid anxiety, and (b) testing the impact of reassurance-seeking on eating pathology and body satisfaction.
First, a systematic review of 14 studies assessing the effectiveness of CBT-ED in reducing comorbid anxiety was conducted. The review suggested that individual, group and computerised CBT-ED may be beneficial in reducing symptoms of anxiety in patients with non-underweight eating disorders. Self-help CBT-ED was not found to be effective in reducing anxiety. These findings have implications for the treatment of non-underweight eating disorders because clinicians have often viewed comorbidity as a reason to deviate from delivering evidence-based therapy. The results suggest that patients with a non-underweight eating disorder and comorbid anxiety may still benefit from CBT-ED. However, this review was based on a limited amount of studies, of varying quality, and should therefore be interpreted with caution. Reasons for the findings are discussed, alongside limitations of the review and the studies included. Further studies are needed, with high-quality research designs, to enable a more comprehensive review to be conducted in this area.
Second, an experimental study was conducted to test whether reassurance-seeking has an impact on eating pathology and body satisfaction. Sixty-four non-clinical participants were randomly allocated to one of three groups (body-related reassurance-seeking group, personality-related reassurance-seeking group, or the control group). Participants in the reassurance-seeking groups were given a reassurance-seeking task relating to either their body or their personality. Participants in the control group did nothing. Outcome measures were administered before and after the experimental phase. The results suggest that body-related and personality-related reassurance-seeking make eating pathology worse but in different ways. Body-related reassurance-seeking significantly increased concerns about weight and shape, and increased fear of uncontrollable weight gain. Personality-related reassurance-seeking significantly increased eating concerns. Body satisfaction was not affected by reassurance-seeking. These results suggest that reassurance-seeking should be considered in the treatment of eating disorders. Recommendations for clinical practice are made, alongside indicators for future research and limitations of the study design.