Are Cognitive Behavioral Therapies Suitable for All Eating Disorders?

Cognitive behavioral therapies hold a central place in the treatment of eating disorders, but their effectiveness is not universal. Their validation is primarily based on studies conducted among white, Western, and neurotypical populations, which limits their relevance for other groups. Neurodivergent individuals, such as those with autism or attention disorders, often experience sensory, emotional, or executive differences that influence how they experience distress and respond to care. For them, these therapies can prove ineffective, or even harmful, as they favor standardized approaches that ignore their specific needs.

Indigenous communities, on the other hand, conceive of mental health through relational, spiritual, and collective frameworks, far removed from Western individualistic models. Current assessment tools and protocols, focused on criteria such as body mass index or specific symptoms, fail to capture the realities experienced by these populations. For example, eating disorders among Indigenous peoples are often linked to food insecurity, the disruption of traditional food systems, or colonial traumas. Health services, designed without their input, struggle to recognize these dimensions and provide appropriate care.

In the field of eating disorders, these gaps are amplified. Diagnostic criteria and standardized treatments overlook varied clinical presentations, such as nighttime snacking behaviors or sensory restrictions, which are more common among marginalized individuals. Testimonies from neurodivergent patients reveal that cognitive behavioral therapies can worsen their suffering by denying their experiences and imposing norms that do not suit them. Studies show that these approaches, by focusing on modifying thoughts and behaviors, fail to address root causes such as sensory difficulties, digestive disorders, or systemic discrimination.

For Indigenous peoples, the gap is even wider. Screening tools and care protocols do not account for their cultural values, which delays diagnoses and limits access to appropriate treatments. Initiatives led by these communities emphasize the importance of developing their own culturally relevant terms and measures to better identify disorders and reduce stigma. Without active involvement from those affected in research and care design, cognitive behavioral therapies risk remaining inadequate, or even dangerous.

The solution lies in overhauling research and care methods. It is essential to include more neurodivergent and Indigenous participants in studies, use culturally relevant outcome indicators, and co-develop interventions with the communities concerned. Only a collaborative and respectful approach to differences will ensure safe and effective care for all.

Bibliographie

Source de l’étude

DOI : https://doi.org/10.1186/s40337-026-01558-1

Titre : Cognitive behavioural therapy is not universally evidence-based: implications for eating disorders

Revue : Journal of Eating Disorders

Éditeur : Springer Science and Business Media LLC

Auteurs : Laurence Cobbaert