Category: Eating Disorders


Targeting Habits in Anorexia Nervosa

Friday, November 17
1:45 PM - 3:15 PM
Location: Aqua 310, Level 3, Aqua Level

Keywords: Eating Disorders | Exposure | Habit Reversal
Presentation Type: Symposium

Background: Our neurocognitive model of the persistence of anorexia nervosa (AN) theorizes that the restrictive eating behavior central to the disorder is habitual (Walsh, 2013). This model is supported by imaging research indicating that habit-related neural systems guide food choice for patients with AN, but not healthy controls (Foerde et al., 2015). Other maladaptive behaviors beyond food choice (e.g., rituals) that maintain low weight may also share characteristics of habits. We have examined the characteristics of a broad range of behaviors seen in AN using the Self Report Habit Index (SRHI). We have also developed and tested a brief behavioral intervention, grounded in habit reversal therapy.


Methods: Adults with AN (n = 16) and healthy controls completed the SRHI for behaviors within 4 domains: restrictive food choices, compensatory behaviors, delay of eating, and eating rituals. The intervention – Regulating Emotions And Changing Habits (REACH) – was developed in an open trial of adults with AN receiving treatment on an inpatient unit (n = 7). Subsequently, 22 patients with AN were randomly assigned to receive either 12 sessions of REACH or Supportive Therapy (ST) adjunctive to the standard inpatient treatment. Habit strength (SRHI) was measured pre- and post-intervention. Patients in the randomized trial also participated in standardized, laboratory meals.


Results: Patients with AN scored significantly higher on the SRHI than healthy controls (ps < 0.05). Examples of self-reported habits for each domain will be provided. In the open trial, patients reported significant improvements in habit strength after receiving REACH. REACH supported a significant improvement in self-reported habit strength and caloric intake at the laboratory meal relative to ST.


Conclusions: The habit model of AN remains compelling. REACH was associated with better caloric intake in a laboratory meal over time than ST, as well as a greater decrease in habit strength. Future work is needed to investigate the value of techniques with a fine-grained focus on behavior, and habitual behavior specifically, in making clinically meaningful and lasting change.

Deborah R. Glasofer

Assistant Professor
Columbia University Medical Center


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Targeting Habits in Anorexia Nervosa

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