Efficacy of Eye Movement Desensitization and Reprocessing (EMDR) Plus Broad Form of Enhanced Cognitive Behavioural Therapy (CBT-Eb) in Patients With Eating Disorders. A Randomized Controlled Trial

Background. The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) distinguishes three broad categories of Eating Disorder (ED): anorexia nervosa (AN), bulimia nervosa (BN), and Other Specified Feeding or Eating Disorder (OSFED). The International Classification of Diseases tenth revision (ICD-10) also reports three categories: anorexia nervosa, bulimia nervosa, and atypical eating disorder.

Anorexia Nervosa (AN). Anorexia nervosa, which primarily affects adolescent girls and young women, is characterized by distorted body image and excessive dieting that lead to severe weight loss with a pathological fear of becoming fat. People affected by anorexia often go to great attempts to hide their behaviour from family and friends. Often people with anorexia have low confidence and poor self-esteem. They can see their weight loss as a positive achievement that can help increase their confidence. It can also contribute to a feeling of gaining control over body weight and shape. The illness can affect people's relationship with family and friends, causing them to withdraw; it can also have an impact on how they perform in education or at work. The seriousness of the physical and emotional consequences of the condition is often not acknowledged or recognised and people with anorexia often do not seek help.

Bulimia Nervosa (BN). Bulimia nervosa is a serious disorder that involves a recurring pattern of binge eating followed by dangerous compensatory behaviours in an effort to counteract or "undo" the calories consumed during the binge. Marked distress regarding binge eating is present. The binge eating occurs, on average, at least once a week for three months. People with bulimia often feel trapped in this cycle of dysregulated eating, and there is a risk for major medical consequences associated with bulimic behaviours.

Other Specified Feeding or Eating Disorder (OSFED). It is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Treatment of Eating Disorders. Guidelines recommended that people with anorexia nervosa should first be offered outpatient treatment and that inpatient care be used for those who do not respond or who present with high risk and little psychosocial resources. Nevertheless the evidence base relating to the treatment of anorexia nervosa is meagre and no first line treatment is identified. Recommendations emphasise the importance of a multi-disciplinary approach including medical, nutritional, social, and psychological components. Among psychotherapies, CBT is one of the suggested treatment. For atypical eating disorders (eating disorders not otherwise specified), in the absence of evidence "it is recommended that the clinician considers following the guidance on the treatment of the eating problem that most closely resembles the individual patient's eating disorder". Regarding bulimia nervosa, CBT-BN is recommended as first-line treatment. CBT-BN has evolved over the past decade in response to a variety of challenges: its procedures have been refined, particularly those addressing patients over evaluation of shape and weight, and it has been adapted to make it suitable for all forms of eating disorder, thereby making it "transdiagnostic" in its scope. This implemented CBT treatment was defined Enhanced CBT. Several studies addressed the efficacy of CBT-E across several eating disorders. In detail, there are two possible CBT treatments for eating disorders, a simpler one, more focused on eating disorders features defined as focused form of Enhanced CBT (CBT-Ef) and another more complex, that addresses external psychopathological processes, named broad form of Enhanced CBT (CBT-Eb). This new version of the treatment also addresses psychopathological processes "external" to the eating disorder, such as clinical perfectionism, low self-esteem or interpersonal difficulties, which interact with the disorder itself.