CBT-E Transdiagnostic Model of Eating Disorders
Fairburn, Cooper & Shafran (2003) · Eating disorders
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
The CBT-E transdiagnostic model (Fairburn, Cooper and Shafran, 2003) holds that eating disorders share one core: self-worth resting mainly, or only, on shape, weight, eating and the sense of controlling them.
CBT-E Transdiagnostic Model of Eating Disorders
Fairburn, Cooper & Shafran (2003)
Over-Evaluation of Shape, Weight & Control
The core mechanism: judging self-worth largely or entirely in terms of shape, weight, eating and the ability to control them — rather than across the range of areas most people use. Everything else in the model flows from, and feeds back into, this over-evaluation.
Strict Dieting / Dietary Restraint
Strict, rigid and extreme dietary rules — restricting the amount, type or timing of food, fasting, calorie limits. Driven by the over-evaluation and itself reinforcing it; the rigidity sets up the conditions for binge eating.
Binge Eating
Binge eating — episodes of eating experienced as out of control — often triggered by breaking a rigid food rule, or by difficult events and moods. (Present in bulimic and binge-type presentations; in pure restriction this step may be absent.)
Compensatory Behaviours
Compensatory behaviours intended to undo eating or control shape and weight — self-induced vomiting, laxative or diuretic misuse, and driven exercise. These maintain both dietary restraint and the over-evaluation, completing the cycle.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
Understanding the model
Eating problems can look very different from person to person, but they often share the same engine. This model — the transdiagnostic CBT-E model — shows what tends to keep them going.
At the centre is how someone judges their own worth. Most people judge themselves on a range of things — relationships, work, interests. In eating disorders, self-worth comes to rest mainly, or only, on shape, weight, eating, and the sense of controlling them. This is called over-evaluation.
Because so much rides on it, people often follow strict, rigid food rules. Dieting this tightly is hard to keep up, and breaking a rule — or a stressful day — can tip into a binge, which feels out of control. That can be followed by trying to undo it: making yourself sick, using laxatives, or driven exercise.
Each of these — the dieting, the bingeing, the compensating — feeds back and strengthens the belief that shape and weight are what matter most, so the whole pattern keeps itself going. For some people, perfectionism, low self-esteem or difficulty coping with feelings add further fuel.
Questions therapists ask about this model.
Frequently asked questions
What maintains an eating disorder in this model?
At the centre is what the model calls over-evaluation: self-worth resting mainly, or only, on shape, weight, eating and the sense of controlling them. Because so much rides on it, food rules become strict and rigid, and dieting that tightly is hard to sustain — breaking a rule, or a stressful day, can tip into a binge that feels out of control, which may then be followed by attempts to undo it. Restriction, bingeing and compensating each feed back and strengthen the belief that shape and weight are what matter most.
How does it relate to the clinical perfectionism model?
They share a structure and an author. Shafran, Cooper and Fairburn (2002) describe self-worth resting on meeting demanding standards; this model describes self-worth resting on shape, weight and eating. In the broader form of CBT-E, perfectionism is one of the additional mechanisms that can maintain the eating problem, so the two formulations are often drawn together for one client rather than chosen between.
Which eating disorders does the model cover?
It is transdiagnostic by design. Fairburn, Cooper and Shafran (2003) argued that anorexia nervosa, bulimia nervosa and the many presentations that fit neither category share the same core, and pointed to how often clients move between these diagnoses over time. The model grew out of the earlier cognitive-behavioural account of bulimia nervosa (Fairburn, Marcus and Wilson, 1993), and not every element applies to everyone: in purely restrictive presentations there may be no binge eating. NICE NG69 covers eating disorders.
Worksheets and reading for this model
Using this model in session — for therapists
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
References
- Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A 'transdiagnostic' theory and treatment. Behaviour Research and Therapy, 41(5), 509–528.
- Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
- Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 361–404). Guilford Press.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Cite this page (APA 7)
Vermani, T. (2026). CBT-E Transdiagnostic Model of Eating Disorders. Formulate. https://formulatetools.co.uk/tools/formulation/eating-disorders-cbt-e
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