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Dissecting the Core Fear in Anorexia Nervosa Can We Optimize Treatment Mechanisms?

Stuart B. Murray, PhD1; Katharine L. Loeb, PhD2; Daniel Le Grange, PhD1
[+] Author Affiliations
1Department of Psychiatry, University of California, San Francisco
2School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey
JAMA Psychiatry. 2016;73(9):891-892. doi:10.1001/jamapsychiatry.2016.1623.
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This Viewpoint argues that individualized exposure therapy distinguishing between fear of food vs weight gain is important for successful management of anorexia nervosa.

Anorexia nervosa (AN) is uniquely placed in the spectrum of psychiatric nosology as the only disorder in which an actualization of the core symptomatic fear (ie, weight gain) is directly targeted as a primary treatment goal. While treatment outcomes are generally indexed along dimensions of both weight-based and cognitive symptomatology, the initial focus on immediate weight restoration raises an important question relating to how the fear of weight gain might be abated throughout treatment when this primary symptomatic fear (ie, weight gain) is targeted and confirmed. Here, we address an important gulf between extinction theory and the practice of exposure therapy for AN.

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Illustration of Learning Pathways on Either the Confirmation or Disconfirmation of Core Fear Expectancies
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