RICCARDO DALLE GRAVE, M. D.

https://doi.org/10.1007/978-3-319-90817-5_23

Abstract

According to transdiagnostic cognitive behavioural theory, the overvaluation of shape and weight is central to maintaining the underlying psychopathology in a large percentage of patients with an eating disorder, irrespective of their DSM classification. Indeed, such patients tend to judge their self-worth largely, or even exclusively, in terms of their shape and weight, and their ability to keep these under control. However, a specific module of a transdiagnostic treatment—enhanced cognitive behavioural therapy (CBT-E)—can be used successfully to address the overvaluation of shape and weight. CBT-E is one of the leading evidence-based treatments for all eating disorder diagnostic categories and targets overvaluation of shape and weight and its expressions in a so-called “body image module”. This module takes an individualized approach and involves two complementary strategies. The first is designed to enhance the importance of other self-evaluation domains, especially in the interpersonal sphere, by helping patients identify any activities or areas of life that they would like to work on and enabling them to do so. The second serves to reduce the importance they place on shape and weight, and to tackle the related behavioural expressions (i.e. body checking, body avoidance, and feeling fat). Although CBT-E can be effectively adapted to all care settings from outpatient to inpatient, challenges do remain. These include the identification of moderators and mediators of treatment response, and the CBT-E dissemination, as few patients are offered it, despite the promising results achieved so far.