Contrast and Comparison of Behavioral, Cognitive-Behavioral, and Comprehensive Treatment Methods for Anorexia Nervosa and Bulimia Nervosa

Eating disorders present with a variety of abnormal beliefs, attitudes, and behaviors that originate from a combination of the central features of the illness itself and the physiological response to starvation or binge-purge activity. Behavioral methods, cognitive-behavioral methods, and comprehensive approaches (which include psychodynamic and pharmacological treatments) all make important contributions to care of patients. Each of these methods has strengths and weaknesses that need to be appreciated to understand which approach is ideal for each of the multiple symptoms present. Psychiatric thinking has often been marked by “either-or” approaches totreatment based on theoretical dogmatism. Pragmatic strategies employ a variety of methods, with a “both-and” attitude towardcomplementary approaches. In general, the more specific the behavioral abnormality, the more likely behavioral methods with contingencies and reinforcements will apply. Behaviors growing out of irrational concepts respond to cognitive-behavioral therapy. Treatment of associated mood disorders, resolution of central dynamic issues, and development of existential meaning require comprehensive approaches. An understanding and rational application of integrated methods leads to effective treatment.