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The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors
Open accessAbstract
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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“These interpersonal difficulties may contribute to the high levels of social withdrawal and isolation that patients with AN often report.”
From Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa? (2020) · cites this paper as Treasure & Schmidt, 2013
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“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.”
From Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa? (2020) · cites this paper as Treasure & Schmidt, 2013
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Vuillier, L., Carter, Z., Teixeira, A. R., & Moseley, R. L. (2020) · Molecular Autism · doi:10.1186/s13229-020-00364-z · Cited by 48
Brown, M. L., & Levinson, C. A. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23728 · Cited by 47
Development and validation of a scale to measure caregiver skills in eating disorders
Hibbs, R., Rhind, C., Salerno, L., Coco, G. L., Goddard, E., Schmidt, U. H., Micali, N., Gowers, S., Beecham, J. K., Macdonald, P., et al. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22362 · Cited by 50
Self-citationComputerised analysis of facial emotion expression in eating disorders
Leppänen, J., Dapelo, M. M., Davies, H. A., Lang, K., Treasure, J. L., & Tchanturia, K. (2017) · PLoS ONE · doi:10.1371/journal.pone.0178972 · Cited by 50
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Coco, G. L., Mannino, G., Salerno, L., Oieni, V., Fratello, C. D., Profita, G., & Gullo, S. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00341 · Cited by 51
Cognitive improvement following weight gain in patients with anorexia nervosa: A systematic review
Hemmingsen, S. D., Wesselhoeft, R. T., Lichtenstein, M. B., Sjögren, J. M., & Støving, R. K. (2020) · European Eating Disorders Review · doi:10.1002/erv.2796 · Cited by 49
The predictive value of the early maladaptive schemas in social situations in anorexia nervosa
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Metadata
- 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)
- PMC
- PMC4081714
- 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
- gold
- doi.org
- Licence
- 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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