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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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“The therapist sees the person: A recent treatment innovation Maudsley Model for Anorexia Nervosa Treatment for adults (MANTRA) has been founded on a comprehensive theoretical basis of a cognitive-interpersonal model of maintenance [95].”
BackgroundMacdonald, P., Rhind, C., Hibbs, R., Goddard, E., Raenker, S., Todd, G., Schmidt, U. H., & Treasure, J. L. (2014) · European Eating Disorders Review · doi:10.1002/erv.2320 · Cited by 27
Self-citationSevere and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?
Gutiérrez, E., & Carrera, O. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.538997 · Cited by 27
Cognitive flexibility, central coherence, and quality of life in anorexia nervosa
Brockmeyer, T., Febry, H., Leiteritz-Rausch, A., Wünsch‐Leiteritz, W., Leiteritz, A., & Friederich, H. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00547-4 · Cited by 31
Shame, Guilt, and Self-Consciousness in Anorexia Nervosa
Panero, M., Longo, P., Bacco, C. D., Daga, G. A., & Martini, M. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11226683 · Cited by 29
Foye, U., Hazlett, D. E., & Irving, P. (2018) · Eating Disorders · doi:10.1080/10640266.2018.1517520 · Cited by 26
Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery
Watson, C., Riazi, A., & Ratcliffe, D. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04424-4 · Cited by 26
Sternheim, L. C., van Passel, B., Dingemans, A. E., Cath, D. C., & Danner, U. N. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.868921 · Cited by 24
Increased Set Shifting Costs in Fasted Healthy Volunteers
Bolton, H., Burgess, P. W., Gilbert, S. J., & Serpell, L. (2014) · PLoS ONE · doi:10.1371/journal.pone.0101946 · Cited by 29
van Passel, B., Danner, U. N., Dingemans, A. E., van Furth, E. F., Sternheim, L. C., Elburg, A. A. V., van Minnen, A., van den Hout, M., Hendriks, G., & Cath, D. C. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1109-x · Cited by 29
Sternheim, L., Danner, U., van Elburg, A., & Harrison, A. (2020) · Brain and Behavior · doi:10.1002/brb3.1588 · Cited by 24
“This social avoidance has been hypothesized to function as a way to reduce the negative emotions that are triggered by social interactions and interpersonal relationships (Treasure & Schmidt, 2013).”
BackgroundMicali, N., Kothari, R., Nam, K. W., Gioroukou, E., Walshe, M., Allin, M. P. G., Rifkin, L., Murray, R. M., & Nosarti, C. (2015) · European Eating Disorders Review · doi:10.1002/erv.2346 · Cited by 25
Harrison, A., Watterson, S. V., & Bennett, S. D. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22993 · Cited by 25
Rowlands, K., Beaty, T., Simic, M., Grafton, B., Hirsch, C. R., Treasure, J. L., & Cardi, V. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23809 · Cited by 25
Self-citationMiles, S., Nedeljkovic, M., & Phillipou, A. (2023) · Eating Disorders · doi:10.1080/10640266.2023.2206751 · Cited by 34
Waterman‐Collins, D., Renwick, B., Lose, A., Kenyon, M., Serpell, L., Richards, L. M., Boughton, N., Treasure, J. L., Schmidt, U. H., & on behalf of the MOSAIC trial group (2014) · European Eating Disorders Review · doi:10.1002/erv.2278 · Cited by 25
Self-citation
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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