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The avoidance paradigm has dominated the psychological conceptualization of anorexia nervosa, for many years. According to that theory, “weight phobia” explains most of the behavioural expressions of the disorder, which are adopted to avoid aversive stimuli (i.e., weight gain and getting fat). However, the conceptualization of anorexia nervosa as a simple phobic disorder is difficult to uphold, as it does not explain the sense of triumph, mastery, self-control and superiority that people suffering from this disorder experience when they are able to control their eating and lose weight. Transdiagnostic cognitive behavioural theory, on the other hand, explains the egosyntonic nature of anorexia nervosa, attributing overvaluation of shape, weight and their control as the core psychopathology of the disorder, and considering weight phobia as a secondary expression of this core psychopathology. The evidence-based “enhanced” cognitive behavioural therapy (CBT-E), derived from this transdiagnostic theory, is not designed to primarily address weight phobia, but rather to help patients develop a more articulated and functional scheme of self-evaluation that is less dependent on shape, weight and their control, by involving the patients actively in the implementation of strategies and procedures that make feel them in control during the process of change.

Weight phobia or overvaluation of shape and weight? A cognitive analysis of the core psychopathology of anorexia nervosa