Chapter 12 - Considerations for Exposure Therapy in Eating Disorder Treatment

Summary

Exposure therapy is a widely recognized and effective treatment for OCD, but it may not work as effectively for EDs. Some of the reasons for poor delivery or treatment manual avoidance are known broadly, but hesitancy can be higher for ED clinicians specifically. EDs have a high mortality and self-harm rate and significant physiological comorbidities, making clinicians more hesitant to utilize certain interventions. Complexities such as starvation effects, the ego-syntonic presentation, and low motivation can compromise exposure therapy. There may be need for reassurance, safety behaviors, and distraction when the primary treatment goal is weight gain. Additionally, there are emotions outside of anxiety that are not effectively treated with exposure (i.e., guilt, disgust, anger). Uniquely, the fears and concerns associated with EDs are also present in the general population. Preoccupation with health, size, and weight is prevalent in society, which affects beliefs about the body and food. This may lead to clinicians overempathizing with patients and can affect the way they facilitate and process food and weight exposures during treatment, all complicating exposure therapy for EDs.