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

Journal of Eating Disorders

Ulrike Schmidt¹  Janet Treasure¹ 

[1] Department of Psychological Medicine, King’s College London, Institute of Psychiatry, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK

关键词: Eating disorder;    Complex intervention;    Model;    Anorexia nervosa;   

Others  :  802827
DOI  :  10.1186/2050-2974-1-13

 received in 2012-12-21, accepted in 2013-02-03,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Treasure and Schmidt; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Fisher CA, Hetrick SE, Rushford N: Family therapy for anorexia nervosa. Cochrane Database Syst Rev 2010, (4):CD004780. Epub 2010/04/16
• [2]Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B: Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry 2010, 67(10):1025-1032. Epub 2010/10/06
• [3]Stiles-Shields C, Hoste RR, Doyle PM, Le Grange D: A review of family-based treatment for adolescents with eating disorders. RRCT 2012, 7(2):133-140. Epub 2012/02/23
• [4]Treasure J, Russell G: The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br. J. Psychiatry: J Ment Sci. 2011, 199(1):5-7. Epub 2011/07/02
• [5]Crane AM, Roberts ME, Treasure J: Are obsessive-compulsive personality traits associated with a poor outcome in anorexia nervosa? A systematic review of randomized controlled trials and naturalistic outcome studies. Int J Eat Disorder 2007, 40(7):581-588. Epub 2007/07/04
• [6]Anckarsater H, Hofvander B, Billstedt E, Gillberg IC, Gillberg C, Wentz E: The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study. Psychol Med 2012, 42(9):1957-1967. Epub 2011/12/22
• [7]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008, 337:a1655. Epub 2008/10/01
• [8]Anderluh MB, Tchanturia K, Rabe-Hesketh S, Treasure J: Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. Am. J. Psych 2003, 160(2):242-247. Epub 2003/02/04
• [9]Jacobi C, Hayward C, De Zwaan M, Kraemer HC, Agras W: Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy. Psychol Bull 2004, 130(1):19-65.
• [10]Roberts ME, Tchanturia K, Treasure JL: Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. J Psychiatr Res 2010, 44(14):964-970.
• [11]Roberts ME, Tchanturia K, Treasure JL: Is attention to detail a similarly strong candidate endophenotype for anorexia nervosa and bulimia nervosa? World J Biol Psychiat: J World Federation Soc Bio Psyc 2012. Epub 2012/01/24
• [12]Kanakam N, Treasure J: A review of cognitive neuropsychiatry in the taxonomy of eating disorders: State, trait, or genetic? Cogn Neuropsychiatry 2012. Epub 2012/09/22
• [13]Alexander-Bloch A, Lambiotte R, Roberts B, Giedd J, Gogtay N, Bullmore E: The discovery of population differences in network community structure: new methods and applications to brain functional networks in schizophrenia. Neuroimage 2012, 59(4):3889-900. Epub 2011/11/29
• [14]Tchanturia K, Davies H, Roberts M, Harrison A, Nakazato M, Schmidt U: Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PLoS One 2012, 7(1):e28331. Epub 2012/01/19
• [15]Tenconi E, Santonastaso P, Degortes D, Bosello R, Titton F, Mapelli D: Set-shifting abilities, central coherence, and handedness in anorexia nervosa patients, their unaffected siblings and healthy controls: exploring putative endophenotypes. J World Federation Soc Bio Psyc 2010, 11(6):813-23. Epub 2010/05/22
• [16]McAnarney ER, Zarcone J, Singh P, Michels J, Welsh S, Litteer T: Restrictive anorexia nervosa and set-shifting in adolescents: a biobehavioral interface. J Adolescent Health: Pub Soc Adolescent Med 2011., 49(1) Epub 2011/06/28
• [17]Buhren K, Mainz V, Herpertz-Dahlmann B, Schafer K, Kahraman-Lanzerath B, Lente C: Cognitive flexibility in juvenile anorexia nervosa patients before and after weight recovery. J Neural Transm 2012. Epub 2012/05/31
• [18]Stedal K, Rose M, Frampton I, Landro NI, Lask B: The neuropsychological profile of children, adolescents, and young adults with anorexia nervosa. Arch Clin Neuropsych: J Nat Acad Neuropsych 2012, 27(3):329-37. Epub 2012/03/15
• [19]Shott ME, Filoteo JV, Bhatnagar KA, Peak NJ, Hagman JO, Rockwell R: Cognitive Set-Shifting in Anorexia Nervosa. Eur Eat Disord Rev: J Eating Disorders Assoc 2012. Epub 2012/04/12
• [20]Holliday J, Tchanturia K, Landau S, Collier D, Treasure J: Is impaired set-shifting an endophenotype of anorexia nervosa? Am J Psychiatry 2005, 162:2269-2275.
• [21]Kothari R, Solmi F, Treasure J, Micali N: The neuropsychological profile of children at high risk of developing an eating disorder. Psychol Med 2012, 1-12. Epub 2012/10/02
• [22]Zastrow A, Kaiser S, Stippich C, Walther S, Herzog W, Tchanturia K: Neural correlates of impaired cognitive-behavioral flexibility in anorexia nervosa. Am. J. Psych 2009, 166(5):608-16. Epub 2009/02/19
• [23]Marsh R, Steinglass JE, Gerber AJ, Graziano O’Leary K, Wang Z, Murphy D: Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Arch Gen Psychiatr 2009, 66(1):51-63. Epub 2009/01/07
• [24]Chase EA, Tait DS, Brown VJ: Lesions of the orbital prefrontal cortex impair the formation of attentional set in rats. Eur J Neurosci 2012, 36(3):2368-75. Epub 2012/06/08
• [25]Stoet G, Snyder LH: Neural correlates of executive control functions in the monkey. Trends Cogn Sci 2009, 13(5):228-34. Epub 2009/04/14
• [26]Meyza KZ, Defensor EB, Jensen AL, Corley MJ, Pearson BL, Pobbe RL: The BTBR T(+)tf/J mouse model for autism spectrum disorders-in search of biomarkers. Behav Brain Res 2012. Epub 2012/09/11
• [27]Amodeo DA, Jones JH, Sweeney JA, Ragozzino ME: Differences in BTBR T + tf/J and C57BL/6J mice on probabilistic reversal learning and stereotyped behaviors. Behav Brain Res 2012, 227(1):64-72. Epub 2011/11/08
• [28]Lopez C, Tchanturia K, Stahl D, Booth R, Holliday J, Treasure J: An examination of the concept of central coherence in women with anorexia nervosa. Int J Eating Disorders 2008, 41(2):143-52. Epub 2007/10/17
• [29]Harrison A, Tchanturia K, Naumann U, Treasure J: Social emotional functioning and cognitive styles in eating disorders. Br J Clin Psychol 2012, 51(3):261-79. Epub 2012/07/19
• [30]Lopez C, Tchanturia K, Stahl D, Treasure J: Weak central coherence in eating disorders: a step towards looking for an endophenotype of eating disorders. J Clin Exp Neuropsyc 2009, 31(1):117-25. Epub 2008/07/09
• [31]Kanakam N, Raoult C, Collier D, Treasure J: Set shifting and central coherence as neurocognitive endophenotypes in eating disorders: A preliminary investigation in twins. World J Biol Psychia: J World Federation Soc Bio Psych 2012. Epub 2012/05/29
• [32]Karwautz A, Wagner G, Waldherr K, Nader I, Fernandez-Aranda F, Estivill X: Gene-environment interaction in anorexia nervosa: Relevance of non-shared environment and the serotonin transporter gene. Mol Psych 2011, 16(6):590-2.
• [33]Fairburn CG, Cooper Z, Doll HA, Welch SL: Risk factors for anorexia nervosa: three integrated case–control comparisons. Arc Gen Psych 1999, 56(5):468-76. Epub 1999/05/08
• [34]McKnight R, Boughton N: A patient’s journey. Anorexia nervosa. BMJ 2009, 339:b3800. Epub 2009/09/26
• [35]Karwautz A, Rabe-Hesketh S, Hu X, Zhao J, Sham P, Collier DA: Individual-specific risk factors for anorexia nervosa: a pilot study using a discordant sister-pair design. Psych Med 2001, 31(2):317-29. Epub 2001/03/10
• [36]Krug I, Penelo E, Fernandez-Aranda F, Anderluh M, Bellodi L, Cellini E: Low social interactions in eating disorder patients in childhood and adulthood: A multi-centre European case control study. J Health Psych 2012, 2012:2012. Epub 2012/04/12
• [37]Kim Y-R, Heo SY, Kang H: Song Kj, Treasure J. Childhood risk factors in Korean women with anorexia nervosa: Two sets of case–control studies with retrospective comparisons. Int J Eating Disorders. 2010, 43(7):589-95.
• [38]Adambegan M, Wagner G, Nader IW, Fernandez-Aranda F, Treasure J, Karwautz A: Internalizing and externalizing behaviour problems in childhood contribute to the development of anorexia and bulimia nervosa-a study comparing sister pairs. Eu Eating Disorders Rev: J Eating Disorders Assoc 2012, 20(2):116-20. Epub 2011/08/10
• [39]Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S: The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust Nz J Psychia 2012, 46(2):118-31. Epub 2012/02/09
• [40]Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Rastam M: Adolescent-onset anorexia nervosa: 18-year outcome. Br. J. Psychiatry: J Men Sci 2009, 194(2):168-74. Epub 2009/02/03
• [41]Menzel JE, Schaefer LM, Burke NL, Mayhew LL, Brannick MT, Thompson JK: Appearance-related teasing, body dissatisfaction, and disordered eating: A meta-analysis. Body Image 2010, 7(4):261-70. Epub 2010/07/27
• [42]Adenzato M, Todisco P, Ardito RB: Social cognition in anorexia nervosa: evidence of preserved theory of mind and impaired emotional functioning. PLoS One 2012, 7(8):e44414. Epub 2012/09/07
• [43]Tiller JM, Sloane G, Schmidt U, Troop N, Power M, Treasure JL: Social support in patients with anorexia nervosa and bulimia nervosa. Int J Eating disorders 1997, 21(1):31-8. Epub 1997/01/01
• [44]Oldershaw A, Dejong H, Hambrook D, Broadbent H, Tchanturia K, Treasure J: Emotional Processing Following Recovery from Anorexia Nervosa. Eu Eating Disorders Rev: J Eating Disorders Assoc 2012. Epub 2012/01/14
• [45]Zucker NL, Losh M, Bulik CM, LaBar KS, Piven J, Pelphrey KA: Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychol Bull 2007, 133(6):976-1006. Epub 2007/10/31
• [46]Cserjesi R, Vermeulen N, Lenard L, Luminet O: Reduced capacity in automatic processing of facial expression in restrictive anorexia nervosa and obesity. Psychia Res 2011, 188(2):253-7. Epub 2011/01/07
• [47]Harrison A, Sullivan S, Tchanturia K, Treasure J: Attentional bias, emotion recognition and emotion regulation in anorexia: state or trait? Bio Psychia 2010, 68(8):755-61.
• [48]Harrison A, Sullivan S, Tchanturia K, Treasure J: Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychol Med 2010, 40(11):1887-97. Epub 2010/01/28
• [49]Cardi V, Matteo RD, Corfield F, Treasure J: Social reward and rejection sensitivity in eating disorders: An investigation of attentional bias and early experiences. World J Biol Psychia: J World Federation Soc Bio Psychia 2012. Epub 2012/03/20
• [50]Watson KK, Werling DM, Zucker NL, Platt ML: Altered social reward and attention in anorexia nervosa. Front Psychol 2010, 1:36. Epub 2010/01/01
• [51]Oldershaw A, Hambrook D, Stahl D, Tchanturia K, Treasure J, Schmidt U: The socio-emotional processing stream in Anorexia Nervosa. Neurosci Biobehav Rev 2011, 35(3):970-88. Epub 2010/11/13
• [52]Dejong H, Van den Eynde F, Broadbent H, Kenyon MD, Lavender A, Startup H: Social cognition in bulimia nervosa: A systematic review. Eu Psychia: J Assoc Eu Psychia 2011. Epub 2011/09/17
• [53]Kenyon M, Samarawickrema N, Dejong H, Van den Eynde F, Startup H, Lavender A: Theory of mind in bulimia nervosa. Int J Eating Disorders. 2012, 45(3):377-84. Epub 2012/01/04
• [54]Oldershaw A, Hambrook D, Tchanturia K, Treasure J, Schmidt U: Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom Med 2010, 72(1):73-9. Epub 2009/12/10
• [55]Kucharska-Pietura K, Nikolaou V, Masiak M, Treasure J: The recognition of emotion in the faces and voice of anorexia nervosa. Int J Eating Disorders. 2004, 35(1):42-7. Epub 2004/01/06
• [56]Zucker N, Moskovich A, Bulik CM, Merwin R, Gaddis K, Losh M: Perception of affect in biological motion cues in anorexia nervosa. Int J Eating Disorders. 2012. Epub 2012/10/31
• [57]Davies H, Schmidt U, Stahl D, Tchanturia K: Evoked facial emotional expression and emotional experience in people with anorexia nervosa. Int J Eating Disorders. 2011, 44(6):531-9. Epub 2010/10/20
• [58]Claes L, Jimenez-Murcia S, Santamaria JJ, Moussa MB, Sanchez I, Forcano L: The facial and subjective emotional reaction in response to a video game designed to train emotional regulation (playmancer). Eu Eating Disorders Rev: J Eating Disorders Assoc 2012, 20(6):484-9. Epub 2012/10/26
• [59]Russell TA, Schmidt U, Doherty L, Young V, Tchanturia K: Aspects of social cognition in anorexia nervosa: affective and cognitive theory of mind. Psychiatry Res 2009, 168(3):181-5. Epub 2009/05/27
• [60]Gillberg IC, Billstedt E, Wentz E, Anckarsater H, Rastam M, Gillberg C: Attention, executive functions, and mentalizing in anorexia nervosa eighteen years after onset of eating disorder. J Clin Exp Neuropsychol 2010, 32(4):358-65. Epub 2009/10/27
• [61]Rozenstein MH, Latzer Y, Stein D, Eviatar Z: Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls. J Affect Disorder 2011, 134(1–3):386-95. Epub 2011/07/16
• [62]Eshkevari E, Rieger E, Longo MR, Haggard P, Treasure J: Increased plasticity of the bodily self in eating disorders. Psych Med 2012, 42(4):819-28. Epub 2011/10/25
• [63]Hatch A, Madden S, Kohn MR, Clarke S, Touyz S, Gordon E: EEG in adolescent anorexia nervosa: impact of refeeding and weight gain. Int J Eating Disorders 2011, 44(1):65-75. Epub 2010/01/12
• [64]McAdams CJ, Krawczyk DC: Impaired neural processing of social attribution in anorexia nervosa. Psychia Res 2011, 194(1):54-63. Epub 2011/08/30
• [65]Cowdrey FA, Harmer CJ, Park RJ, McCabe C: Neural responses to emotional faces in women recovered from anorexia nervosa. Psychia Res 2012, 201(3):190-5. Epub 2012/04/03
• [66]Powell J, Lewis PA, Roberts N, Garcia-Finana M, Dunbar RI: Orbital prefrontal cortex volume predicts social network size: an imaging study of individual differences in humans. Proc Bio Sci/Royal Soc 2012, 279(1736):2157-62. Epub 2012/02/03
• [67]Dunbar R: Psychology. Evolution of the social brain. Science 2003, 302(5648):1160-1. Epub 2003/11/15
• [68]Freeberg TM, Dunbar RI, Ord TJ: Social complexity as a proximate and ultimate factor in communicative complexity. Philos Trans R Soc Lond B Biol Sci London Series B, Biol Sci 2012, 367(1597):1785-801. Epub 2012/05/30
• [69]Lawson EA, Donoho DA, Blum JI, Meenaghan EM, Misra M, Herzog DB: Decreased nocturnal oxytocin levels in anorexia nervosa are associated with low bone mineral density and fat mass. J Clin Psychia 2011, 72(11):1546-51. Epub 2011/09/10
• [70]Demitrack MA, Lesem MD, Listwak SJ, Brandt HA, Jimerson DC, Gold PW: CSF oxytocin in anorexia nervosa and bulimia nervosa: clinical and pathophysiologic considerations. Am J Psychia 1990, 147(7):882-6. Epub 1990/07/01
• [71]Lawson EA, Holsen LM, Santin M, Meenaghan E, Eddy KT, Becker AE: Oxytocin secretion is associated with severity of disordered eating psychopathology and insular cortex hypoactivation in anorexia nervosa. J Clin Endocrinol Metab 2012, 97(10):E1898-908. Epub 2012/08/09
• [72]Sternheim L, Startup H, Pretorius N, Johnson-Sabine E, Schmidt U, Channon S: An experimental exploration of social problem solving and its associated processes in anorexia nervosa. Psychia Res 2012, 200(2–3):524-9. Epub 2012/07/20
• [73]Zabala MJ, Macdonald P, Treasure J: Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: a systematic review. Eu Eating Disorders Rev: J Eating Disorders Assoc 2009, 17(5):338-49. Epub 2009/04/16
• [74]Treasure J, Sepulveda AR, MacDonald P, Whitaker W, Lopez C, Zabala M: The assessment of the family of people with eating disorders. Eu Eating Disorders Rev: J Eating Disorders Assoc 2008, 16(4):247-55. Epub 2008/02/02
• [75]Sepulveda AR, Kyriacou O, Treasure J: Development and validation of the accommodation and enabling scale for eating disorders (AESED) for caregivers in eating disorders. BMC Health Services Res 2009, 9:171. Epub 2009/09/25 BioMed Central Full Text
• [76]Grover M, Naumann U, Mohammad-Dar L, Glennon D, Ringwood S, Eisler I: A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa. Psych Med 2011, 1-11. Epub 2011/07/08
• [77]Grover M, Williams C, Eisler I, Fairbairn P, McCloskey C, Smith G: An off-line pilot evaluation of a web-based systemic cognitive-behavioral intervention for carers of people with anorexia nervosa. Int J Eating Disorders 2011, 44(8):708-15. Epub 2011/11/11
• [78]Goddard E, Macdonald P, Sepulveda AR, Naumann U, Landau S, Schmidt U: Cognitive interpersonal maintenance model of eating disorders: intervention for carers. Brit J Psychia: J Men Sci 2011, 199(3):225-31. Epub 2011/07/06
• [79]Raenker S, Hibbs R, Goddard E, Naumann U, Arcelus J, Ayton A: Caregiving and coping in carers of people with anorexia nervosa admitted for intensive hospital care. Int J Eating Disorders 2012. Epub 2012/10/31
• [80]Wade TD, Treasure J, Schmidt U: A case series evaluation of the Maudsley Model for treatment of adults with anorexia nervosa. Eu Eating Disorders Rev: J Eating Disorders Assoc 2011. Epub 2011/02/01
• [81]Schmidt U, Oldershaw A, Jichi F, Sternheim L, Startup H, McIntosh V: Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Brit J Psychiat: J Men Sci 2012, 201:392-9. Epub 2012/09/22
• [82]MacLeod C, Mathews A: Cognitive bias modification approaches to anxiety. Annu Rev Clin Psycho 2012, 8:189-217. Epub 2011/11/01
• [83]Beard C, Sawyer AT, Hofmann SG: Efficacy of attention bias modification using threat and appetitive stimuli: a meta-analytic review. Behav Ther 2012, 43(4):724-40. Epub 2012/10/11
• [84]Meyer-Lindenberg A, Domes G, Kirsch P, Heinrichs M: Oxytocin and vasopressin in the human brain: social neuropeptides for translational medicine. Nat Rev Neurosci 2011, 12(9):524-38. Epub 2011/08/20
• [85]Van den Eynde F, Guillaume S, Broadbent H, Campbell IC, Schmidt U: Repetitive transcranial magnetic stimulation in anorexia nervosa: A pilot study. Eu Psychiat: J Assoc Eu Psychiat 2011. Epub 2011/09/02