Cited by 646Eating Disorders and BehaviorsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNutrition, Health and Food Behavior

The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors

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Treasure, Janet, Schmidt, Ulrike·2013·Journal of Eating Disorders

Abstract

AIM: To describe the evidence base relating to the Cognitive-Interpersonal Maintenance Model for anorexia nervosa (AN). BACKGROUND: A Cognitive-Interpersonal Maintenance Model maintenance model for anorexia nervosa was described in 2006. This model proposed that cognitive, socio-emotional and interpersonal elements acted together to both cause and maintain eating disorders. METHOD: A review of the empirical literature relating to the key constructs of the model (cognitive, socio-emotional, interpersonal) risk and maintaining factors for anorexia nervosa was conducted. RESULTS: Set shifting and weak central coherence (associated with obsessive compulsive traits) have been widely studied. There is some evidence to suggest that a strong eye for detail and weak set shifting are inherited vulnerabilities to AN. Set shifting and global integration are impaired in the ill state and contribute to weak central coherence. In addition, there are wide-ranging impairments in socio-emotional processing including: an automatic bias in attention towards critical and domineering faces and away from compassionate faces; impaired signalling of, interpretation and regulation of emotions. Difficulties in social cognition may in part be a consequence of starvation but inherited vulnerabilities may also contribute to these traits. The shared familial traits may accentuate family members' tendency to react to the frustrating and frightening symptoms of AN with high expressed emotion (criticism, hostility, overprotection), and inadvertently perpetuate the problem. CONCLUSION: The cognitive interpersonal model is supported by accumulating evidence. The model is complex in that cognitive and socio-emotional factors both predispose to the illness and are exaggerated in the ill state. Furthermore, some of the traits are inherited vulnerabilities and are present in family members. The clinical formulations from the model are described as are new possibilities for targeted treatment.

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Crossref · 10.1186/2050-2974-1-13

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  • Interpersonal difficulties may contribute to high levels of social withdrawal and isolation in patients with anorexia nervosa.

    “These interpersonal difficulties may contribute to the high levels of social withdrawal and isolation that patients with AN often report.”
  • In conclusion, one of the factors underlying the interpersonal maintaining factors of AN might be suboptimal social problem-solving skills, and these inefficient skills may be due to anxiety and high intolerance of uncertainty, which could be ameliorated in treatment as a means of better supporting the social and cognitive skills of people with AN.

    “In conclusion, this study has shown that one of the factors underlying the interpersonal maintaining factors of AN (Fairburn, 2008; Treasure & Schmidt, 2013) might be suboptimal social problem solving skills and these inefficient skills may be due to anxiety and high IU, which could be ameliorated in treatment as a means of better supporting the social and cognitive skills of people with AN.”

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Authors
Treasure, J., & Schmidt, U.
Affiliations
King's College London (GB)
Corresponding author
Treasure, Janet
Venue
Journal of Eating Disorders
Published
2013-04-15
Volume
1
Issue
1
Pages
13-13
ISSN
2050-2974 (ISSN-L)
OpenAlex
W2128692360
Cited by
646
References
88
Citations by year
2026: 30 · 2025: 53 · 2024: 51 · 2023: 48 · 2022: 58 · 2021: 66 · 2020: 71 · 2019: 46 · 2018: 43 · 2017: 47 · 2016: 45 · 2015: 46 · 2014: 31 · 2013: 9
FWCI
6.45
Type
journal article
Language
en
Open access
Locations
  • Journal of Eating Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
Funders
National Institute for Health and Care Research (RP-PG-0606-1043)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
anorexia nervosa, risk factors, maintaining factors, set-shifting, weak central coherence, obsessive-compulsive traits, socio-emotional processing, emotion regulation, social cognition, expressed emotion, family vulnerability

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