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An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): Causal pathways and treatment implications
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Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPT's efficacy as an intervention for individuals with an eating disorder.
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“interpersonal difficulties are thought to be so key to AN that these difficulties are targeted in recent treatment protocols (Maudsley Anorexia Nervosa Treatment for Adults; MANTRA, (Schmidt, Wade, & Treasure, 2014, Interpersonal Therapy for Eating Disorders; IPT‐ED; Rieger et al., 2010).”
From Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa? (2020) · cites this paper as Rieger et al., 2010
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“Other Theories One study identified by our review was grounded in the interpersonal theory of eating disorders (Rieger et al. 2010) and revealed that feedback on Facebook has been shown to be associated with higher levels of body image and eating concerns at a later date (Hummel and Smith 2015).”
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“In the eating disorder field, Rieger et al. (2010) proposed that social evaluation of appearance leads to symptoms such as disordered eating in those individuals who place emphasis on their physical appearance.”
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Psychological Treatments for Binge Eating Disorder
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Self-citationPsychological treatments for eating disorders
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“As noted, social evaluative stress may be particularly relevant in eliciting binge eating behavior (Rieger et al., 2010).”
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Treasure, J., Corfield, F., & Cardi, V. (2012) · European Eating Disorders Review · doi:10.1002/erv.2181 · Cited by 128
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Self-citationAn open trial evaluating an attention bias modification program for overweight adults who binge eat
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“BED participants correctly identified food stimuli targets presented shortly after neutral targets more than overweight non-BED controls, demonstrating increased (biased) food perception in BED (Svaldi et al., 2014).”
BackgroundInfluentialMarzilli, E., Cerniglia, L., & Cimino, S. (2018) · Adolescent Health, Medicine and Therapeutics · doi:10.2147/ahmt.s148050 · Cited by 107
“…73 which are specifically focused on physical activity and modifying diet to reduce overweight and obesity; 3) interpersonal psychotherapy (IPT), 69,75 a short-term psychotherapy focused on reducing interpersonal difficulties associated with the onset and/or maintenance of BED; and 4) dialectical…”
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“Some of these models postulate that is the potential or actual rejection based on body image and weight that specifically predispose to the risk of developing eating disorder symptoms, as opposed to other psychiatric disorders [44, 46].”
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“Negative social evaluation and sensitivity to rejection are both proposed as key causal and maintaining factors in ED [67] and maintaining change following treatment is associated with support, a non-judgemental stance, letting people in and trust [12].”
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“In support of this, theoretical models of eating pathology suggest that distress from negative social evaluation detrimentally affects self-evaluation, including body esteem [52].”
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“Models of treatment for eating disorders (ED) are beginning to focus on emotional and interpersonal processes (Wonderlich, Mitchell, Peterson & Crow, 2001; Cooper, Wells & Todd, 2004; Schmidt & Treasure, 2006; Waller, Kennerley & Ohanian, 2007; Fairburn, Cooper & Shafran, 2008; Rieger et al., 2010; Wildes & Marcus, 20…”
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Self-citationAttachment theory and hoarding disorder: A review and theoretical integration
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“It is possible the added content infused throughout the program targeting interpersonal functioning and affect regulation was helpful for improving depressive symptomatology among this group (Rieger et al., 2010; Wilfley, Iacovino, & Van Buren, 2012).”
BackgroundSelf-citationBiased Interpretation of Ambiguous Social Scenarios in Anorexia Nervosa
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“Theory suggests that low self-esteem is related to both behavioral and cognitive-affective symptoms (Fairburn et al., 2003; Rieger et al., 2010; Serpell & Troop, 2003), but little empirical information is available on this issue.”
BackgroundMonteleone, A. M., Cascino, G., Marciello, F., Daga, G. A., Baiano, M., Balestrieri, M., Barone, E., Bertelli, S., Carpiniello, B., Castellini, G., et al. (2021) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-020-01097-x · Cited by 67
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Psychotherapies for eating disorders: findings from a rapid review
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“Data from behavioral studies have suggested a negative bias in social relationships: patients with AN perceive low reward from- and are avoidant of- social contexts and are oversensitive and attention-biased towards rejection [1,36–40].”
BackgroundThe structure and reliability of the Clinical Perfectionism Questionnaire
Dickie, L., Surgenor, L. J., Wilson, M., & McDowall, J. (2012) · Personality and Individual Differences · doi:10.1016/j.paid.2012.02.003 · Cited by 56
“CP is argued as the clearest conceptualisation of pathological perfectionism (Shafran, Cooper, & Fairburn, 2003; Shafran et al., 2002) and has been applied to a range of conditions particularly eating disorders (Rieger et al., 2010; Riley, Lee, Cooper, Fairburn, & Shafran, 2007).”
BackgroundCardi, V., Esposito, M., Bird, G., Rhind, C., Yiend, J., Schifano, S., Hirsch, C. R., & Treasure, J. L. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.019 · Cited by 55
Behavioral evidence of emotion dysregulation in binge eaters
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“Following the principles of negative reinforcement, this model posits that binge eating becomes a learned behavior to cope with this increased negative affect, albeit in a maladaptive way (Arnow, Kenardy, & Agras, 1992; Cooper, Wells, & Todd, 2004; Rieger et al., 2010).”
InfluentialInterpersonal psychotherapy for eating disorders: current perspectives
Miniati, M., Callari, A., Maglio, A., & Calugi, S. (2018) · Psychology Research and Behavior Management · doi:10.2147/prbm.s120584 · Cited by 57
“Fairburn et al published two RCTs of IPT for patients with BN. 11,18 The first study was on 75 patients randomized to cognitive-behavioral therapy for BN (CBT-BN; n = 25), behavioral therapy for BN (BT; n = 25) or IPT (n = 25).”
InfluentialMonteleone, A. M., Tzischinsky, O., Cascino, G., Alon, S., Pellegrino, F., Ruzzi, V., & Latzer, Y. (2021) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-021-01169-6 · Cited by 54
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“ICAT Momentary Triggers Thus far, empirical and theoretical work has implicated the role of interpersonal problems and negative social evaluation as precipitants of ED symptoms (Ansell, Grilo, & White, 2012; Ivanova et al., 2015; Rieger et al., 2010; Wilfley et al., 2000).”
BackgroundNegative Social-Evaluative Fears Produce Social Anxiety, Food Intake, and Body Dissatisfaction
Levinson, C. A., & Rodebaugh, T. L. (2014) · Clinical Psychological Science · doi:10.1177/2167702614548891 · Cited by 50
“If individuals are feeling evaluated overall, they may regulate their fears by using foodrelated habits (e.g., Muraven & Baumeister, 2000; Rieger et al., 2010; Walsh, 2013).”
BackgroundInterpersonal problems and developmental trajectories of binge eating disorder
Blomquist, K. K., Ansell, E. B., White, M. A., Masheb, R. M., & Grilo, C. M. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.05.003 · Cited by 48
“It may be that, consistent with interpersonal theories on loss of control [8,9], these problematic interpersonal styles result in negative social evaluation, leading to low self-esteem and emotion dysregulation and/or negative affect that trigger maladaptive eating patterns to cope with the negative affect.”
BackgroundResultInfluentialLanguage Use in Eating Disorder Blogs
Wolf, M., Theis, F., & Kordy, H. (2013) · Journal of Language and Social Psychology · doi:10.1177/0261927x12474278 · Cited by 59
“On an interpersonal level, social withdrawal is a common consequence driven by the individual’s fears of negative social evaluations and rejection (Rieger et al., 2010), leading to a vicious circle in which dysfunctional behaviors begin to replace real-world interactions (Schmidt & Treasure, 2006).”
Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974–2017)
Ravitz, P., Watson, P., Lawson, A., Constantino, M. J., Bernecker, S. L., Park, J., & Swartz, H. A. (2019) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000219 · Cited by 49
Dakanalis, A., Carrà, G., Calogero, R. M., Zanetti, M. A., Volpato, C., Riva, G., Clerici, M., & Cipresso, P. (2015) · Child Psychiatry & Human Development · doi:10.1007/s10578-015-0551-1 · Cited by 47
“It has been claimed that individuals who are or become anxious and concerned about being negatively evaluated by others because of their own appearancemay bemore driven to (a) control and restrict their quantity and/or quality of the food consumed in an attempt to anticipate and ward off potentially negative judgment…”
BackgroundResultInfluentialAlbano, G., Rowlands, K., Baciadonna, L., Coco, G. L., & Cardi, V. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.09.039 · Cited by 48
“Journal of Cognitive Psychotherapy, 2014.”
BackgroundMiller, A. E., Trolio, V., Halicki‐Asakawa, A., & Racine, S. E. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23731 · Cited by 44
Vannucci, A., Nelson, E. E., Bongiorno, D. M., Pine, D. S., Yanovski, J. A., & Tanofsky‐Kraff, M. (2015) · Psychological Medicine · doi:10.1017/s003329171500104x · Cited by 47
“Negative affect is prominent in existing theories, which propose that LOC eating represents a maladaptive attempt to escape or alleviate negative emotions in response to psychosocial stressors (Hawkins & Clement, 1984; Heatherton & Baumeister, 1991; Fairburn et al. 2003; Rieger et al. 2010).”
BackgroundSelf-citationBinge eating disorder: The next generation of research
Tanofsky‐Kraff, M., Bulik, C. M., Marcus, M. D., Weissman, R. S., Wilfley, D. E., Wonderlich, S. A., & Hudson, J. I. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22089 · Cited by 50
Self-citationFacebook usage among those who have received treatment for an eating disorder in a group setting
Saffran, K., Fitzsimmons‐Craft, E. E., Kass, A. E., Wilfley, D. E., Taylor, C. B., & Trockel, M. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22567 · Cited by 43
Self-citationPeterson, C. B., Berg, K. C., Crosby, R. D., Lavender, J. M., Accurso, E. C., Ciao, A. C., Smith, T. L., Klein, M. H., Mitchell, J. E., Crow, S. J., et al. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22669 · Cited by 47
“Identifying these treatments’ influence on putative maintenance mechanisms of psychopathology is especially critical to determine how these particular treatments may work as well as to improve and develop more effective interventions (Rieger et al., 2010; Strauman and Merrill, 2004).”
de Paoli, T., Fuller-Tyszkiewicz, M., Halliwell, E., Puccio, F., & Krug, I. (2017) · European eating disorders review · doi:10.1002/erv.2537 · Cited by 35
“All rights reserved. study tests an expanded form of the IPT-ED model, by incorporating these additional paths, and testing a whole model rather than individual components in isolation.”
BackgroundMethodInfluentialZanella, E., & Lee, E. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e11422 · Cited by 57
“Interpersonal theory and emotional regulation theory explain social factors, as individuals often engage in dysfunctional eating as maladaptive stress responses to interpersonal problems and emotional stress reactivity (Ansell et al., 2012; Ciarma and Mathew, 2017; Rieger et al., 2010; Scholtz et al., 2011).”
Perception of Peripersonal and Interpersonal Space in Patients with Restrictive‐type Anorexia
Nandrino, J., Ducro, C., Iachini, T., & Coello, Y. (2017) · European Eating Disorders Review · doi:10.1002/erv.2506 · Cited by 41
Monteleone, A. M., Ruzzi, V., Patriciello, G., Cascino, G., Pellegrino, F., Vece, A., Monteleone, P., & Maj, M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.051 · Cited by 30
Monteleone, A. M., Cardi, V., Volpe, U., Fico, G., Ruzzi, V., Pellegrino, F., Castellini, G., Monteleone, P., & Maj, M. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.002 · Cited by 44
Raykos, B. C., McEvoy, P. M., & Fursland, A. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22740 · Cited by 39
Managing Stigma: Disclosure-Response Communication Patterns in Pro-Anorexic Websites
Chang, P. F., & Bazarova, N. N. (2015) · Health Communication · doi:10.1080/10410236.2014.946218 · Cited by 47
“Consequently those who feel stigmatized can have negative reactions to these opinions, ultimately feeling hostility toward the opinion holders because of the negative social evaluation and rejection (Rieger et al., 2010), leading to a cycle of blame and hostility (Schmidt & Treasure, 2006).”
BackgroundThe social psychology of disordered eating: The Situated Identity Enactment model
Cruwys, T., Platow, M. J., Rieger, E., Byrne, D. G., & Haslam, S. A. (2016) · European Review of Social Psychology · doi:10.1080/10463283.2016.1229891 · Cited by 42
“and family-based therapy acknowledge the interplay between patients and their social environment, and offer some ideas for how to address social factors in the eating disorder context (Rieger et al., 2010).”
BackgroundSelf-citationObesity and Interpersonal Problems: An Analysis with the Interpersonal Circumplex
Coco, G. L., Gullo, S., Scrima, F., & Bruno, V. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.753 · Cited by 38
Duarte, C., & Pinto‐Gouveia, J. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2016.07.005 · Cited by 37
“…are developed and maintained as a means of temporarily reducing or escaping the experience of negative emotions (Heatherton & Baumeister, 1991), particularly emotions associated with negative self-evaluations, criticism from others and other complex interpersonal difficulties (Rieger et al., 2010).”
A network analysis of borderline personality disorder symptoms and disordered eating
Paoli, T. D., Fuller‐Tyszkiewicz, M., Huang, C., & Krug, I. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22916 · Cited by 37
“Examples of such treatments are dialectical behavioral therapy (DBT; Linehan, 1987), interpersonal therapy (Rieger et al., 2010), and emotion regulation training programs (Berking, Ebert, Cuijpers, & Hofmann, 2013).”
BackgroundExamination of the interpersonal model of loss of control eating in the laboratory
Shank, L. M., Crosby, R. D., Grammer, A. C., Shomaker, L. B., Vannucci, A., Burke, N. L., Stojek, M., Brady, S. M., Kozlosky, M., Reynolds, J. C., et al. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.03.015 · Cited by 35
Self-citationTurton, R., Cardi, V., Treasure, J. L., & Hirsch, C. R. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.089 · Cited by 34
Ambwani, S., Slane, J. D., Thomas, K. M., Hopwood, C. J., & Grilo, C. M. (2014) · Eating Behaviors · doi:10.1016/j.eatbeh.2014.08.005 · Cited by 34
Brochu, J. P., Meilleur, D., Meglio, G. D., Taddeo, D., Lavoie, É., Erdstein, J., Pauzé, R., Pesant, C., Thibault, I., & Frappier, J. (2018) · Eating Disorders · doi:10.1080/10640266.2018.1454806 · Cited by 35
“Psychological factors: low self-esteem and negative mood More recently, researchers and theorists have argued for the importance of examining potential mediating factors that could explain the link between poor-quality relationships and ED (Champion & Power, 2012; Rieger et al., 2010).”
BackgroundResultInfluentialGriffiths, S., Mitchison, D., Murray, S. B., Mond, J. M., & Bastian, B. B. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22932 · Cited by 33
Matheson, E. L., Wade, T. D., & Yiend, J. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101482 · Cited by 32
Coco, G. L., Gullo, S., Salerno, L., & Iacoponelli, R. (2010) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2010.06.002 · Cited by 29
“The Eating Disorder-Specific Model of Interpersonal Psychotherapy [51] proposes that disturbances in self-evaluation and affect triggered by negative social evaluation result in eating disorder symptoms.”
BackgroundTraining Models for Implementing Evidence-Based Psychological Treatment
Wilfley, D. E., Agras, W. S., Fitzsimmons‐Craft, E. E., Bohon, C., Eichen, D. M., Welch, R. R., Jo, B., Raghavan, R., Proctor, E. K., & Wilson, G. T. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.3483 · Cited by 29
Self-citationSternheim, L., Startup, H., Pretorius, N., Johnson-Sabine, E., Schmidt, U., & Channon, S. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.06.029 · Cited by 29
Meneguzzo, P., Terlizzi, S., Maggi, L., & Todisco, P. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152493 · Cited by 30
Does the Interpersonal Model Generalize to Obesity Without Binge Eating?
Coco, G. L., Sutton, R. S., Tasca, G. A., Salerno, L., Oieni, V., & Compare, A. (2016) · European Eating Disorders Review · doi:10.1002/erv.2459 · Cited by 28
Portingale, J., Fuller‐Tyszkiewicz, M., Liu, S., Eddy, S., Liu, X., Giles, S., & Krug, I. (2022) · Body Image · doi:10.1016/j.bodyim.2022.01.005 · Cited by 28
Mushquash, A. R., & Sherry, S. (2013) · Eating Behaviors · doi:10.1016/j.eatbeh.2013.02.002 · Cited by 28
Interpersonal problem areas and alexithymia in adolescent girls with loss of control eating
Berger, S. S., Elliott, C. A., Ranzenhofer, L. M., Shomaker, L. B., Hannallah, L. M., Field, S. E., Young, J. F., Sbrocco, T., Wilfley, D. E., Yanovski, J. A., et al. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.08.005 · Cited by 29
“Taken together, adolescents with interpersonal deficits may represent a vulnerable subset of LOC youth who are more likely to exhibit severe eating-related and general psychopathology than youth with other interpersonal problem areas.”
BackgroundSelf-citationWang, W., Chen, Z., & Ding, X. (2022) · Appetite · doi:10.1016/j.appet.2022.106267 · Cited by 26
Sternheim, L., Danner, U., van Elburg, A., & Harrison, A. (2020) · Brain and Behavior · doi:10.1002/brb3.1588 · Cited by 24
“In fact, interpersonal difficulties are thought to be so key to AN that these difficulties are targeted in recent treatment protocols (Maudsley Anorexia Nervosa Treatment for Adults; MANTRA, (Schmidt, Wade, & Treasure, 2014, Interpersonal Therapy for Eating Disorders; IPT-ED; Rieger et al., 2010).”
BackgroundScorsolini‐Comin, F., & dos Santos, M. A. (2012) · Estudos de Psicologia (Campinas) · doi:10.1590/s0103-166x2012000500021 · Cited by 25
Monteleone, A. M., Cascino, G., Ruzzi, V., Pellegrino, F., Carfagno, M., Raia, M., Giorno, C. D., Monteleone, P., & Maj, M. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.07.039 · Cited by 25
Group Behavioral Activation for Patients With Severe Obesity and Binge Eating Disorder
Alfonsson, S., Parling, T., & Ghaderi, A. (2014) · Behavior Modification · doi:10.1177/0145445514553093 · Cited by 26
“The mechanisms of change in IPT treatment for BED are not well understood but it is suggested that helping the patient to develop relationships that can serve as a context for naturally reinforced behaviors might provide an alternative to dysfunctional affect regulation strategies such as binge eating (Rieger et al.,…”
BackgroundThe Mediating Effect of Specific Social Anxiety Facets on Body Checking and Avoidance
Radix, A. K., Rinck, M., Becker, E. S., & Legenbauer, T. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02661 · Cited by 26
“Similarly, FNE has also been theorized to trigger BC (Rieger et al., 2010).”
BackgroundThe influence of social anxiety on the body checking behaviors of female college students
White, E. K., & Warren, C. S. (2014) · Body Image · doi:10.1016/j.bodyim.2014.07.008 · Cited by 23
Al-Salom, P., & Boylan, K. (2019) · Europe PMC (PubMed Central) · Cited by 23
Rowlands, K., Grafton, B., Cerea, S., Simic, M., Hirsch, C. R., Cruwys, T., Yellowlees, R., Treasure, J. L., & Cardi, V. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.013 · Cited by 24
Perception of affect in biological motion cues in anorexia nervosa
Zucker, N. L., Moskovich, A. A., Bulik, C. M., Merwin, R. M., Gaddis, K., Losh, M. C., Piven, J., Wagner, H. R., & LaBar, K. S. (2012) · International Journal of Eating Disorders · doi:10.1002/eat.22062 · Cited by 22
“This approach is less arbitrary and more accurately reflects the inter-individual clinical complexity of AN.”
BackgroundInfluential
Metadata
- Authors
- Rieger, E., Van Buren, D. J., Bishop, M., Tanofsky-Kraff, M., Welch, R., & Wilfley, D. E.
- Affiliations
- Australian National University (AU)
- Washington University in St. Louis (US)
- Corresponding author
- Rieger, Elizabeth
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 30
- Issue
- 4
- Pages
- 400-410
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2073773509
- Cited by
- 279
- References
- 154
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 22 · 2023: 19 · 2022: 21 · 2021: 24 · 2020: 16 · 2019: 21 · 2018: 16 · 2017: 19 · 2016: 18 · 2015: 18 · 2014: 15 · 2013: 14 · 2012: 16
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Psychology Review (publishedVersion, public-domain)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- interpersonal psychotherapy, eating disorders, self-assessment, emotion regulation, clinical perfectionism, cognitive impairment, adolescent development, therapeutic mechanisms, causal pathways
- MeSH terms
- Affect, Feeding and Eating Disorders, Humans, Interpersonal Relations, Models, Psychological, Psychotherapy, Self Concept, Social Perception
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