Couples Therapy: A New Approach to Treating Anorexia Nervosa

Treating both partners can improve outcome.

Treating adult anorexia (AN) patients and their partners can improve both outcome and help strengthen their relationships, according to early results from a novel couple-based behavioral intervention program.

The Uniting Couples in the Treatment of Anorexia Nervosa (UCAN) program at the University of North Carolina, Chapel Hill, belies the stereotype that patients with AN avoid committed relationships. On the contrary, according to Dr. Cynthia Bulik and colleagues, a substantial proportion of people seeking treatment for AN are in relationships and report that their partners are an essential part of the recovery process (Int J Eat Disord 2010; 44:19). In fact, in an earlier study, when Dr. Bulik and colleagues followed 70 women treated for AN 10 years, the one factor credited for recovery was having a supportive partner (Int J Eat Disord 2003; 33:143).

How the UCAN program works

The UCAN program is based on the premise that although one member of the couple has AN, the disorder occurs in an interpersonal and social context. For married patients or those in a committed relationship, the partner is a central part of their social environment and thus can contribute to improvement or conversely may help maintain or even exacerbate AN. While many partners want to help, they often don’t know how to do so and may unknowingly make the situation worse.

Dr. Bulik and colleagues use a three-phase approach in the UCAN program. The initial phase of treatment focuses on understanding the couple’s experience with AN and on educating the couple about the disorder and recovery process, and then teaching them effective communication skills. Creating a shared understanding of AN sets the stage for a greater sense of teamwork and leads to improved communication and problem-solving skills.

In the second phase, the couple is guided through the areas of AN they find most challenging, including purging, binge eating, and secrecy. They learn to use their communication skills to respond to these challenges—as a team. Then, the treatment team broadens the focus to include body image and sexual issues as they relate to the eating disorder. As Dr. Bulik colleagues write, the focus on body image provides a natural approach to the couple’s physical relationship, and the couple is helped to develop healthier patterns appropriate for them.

The final phase brings treatment to a close by discussing ways to prevent relapse and the next steps for the couple after the UCAN program ends. The couple learns to differentiate slips from relapses, and ways to effectively respond to each if they do occur.

A program designed for committed partners

Dr. Bulik notes that the UCAN program was developed for individuals in committed relationships who are living together as an independent couple. Because treatment focuses on highly personal areas, it is not appropriate for a group format. Also, the program will work only when a relationship feels safe and when the couple does not have frequent negative interactions revolving around AN. Since co-morbidities such as Axis I and Axis II disorders and symptoms are often a part of AN, a UCAN therapist must be experienced and have a solid understanding of AN and related disorders, in addition to skill in addressing couples issues.

The UCAN program is currently being evaluated in a clinical trial, and ultimately the authors believe the approach can be adapted for couples’ intervention for bulimia nervosa and binge eating disorder as well. The UCAN program is also being adapted for Latino populations.