The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

Janet Treasure, Daniel Willmott, Suman Ambwani, Valentina Cardi, Danielle Clark Bryan, Katie Rowlands, and Ulrike Schmidt. Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness, in "Advances in Eating Disorders, ed. Zaida Aguera and Susana Jiménez-Murcia, special issue, Journal of Clinical Medicine 9, no. 3 (2020): 630. https://www.mdpi.com/2077-0383/9/3/630

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an Open Access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Suman Ambwani is a professor of Psychology at Dickinson College.

This published version is made available on Dickinson Scholar with the permission of the publisher. For more information on the published version, visit MDPI's Website. https://www.mdpi.com/2077-0383/9/3/630

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