Uniting Couples in the treatment of Anorexia Nervosa (UCAN2) is a collaborative treatment research study between the University of North Carolina (UNC) Eating Disorders Program and the UNC Department of Psychology and is funded by the National Institute of Mental Health. The study examines two comprehensive treatments as couples face the challenges of anorexia nervosa (AN). The program helps patients with AN and their partners address AN symptoms and unique stresses that AN places on the romantic relationship.

No single, conventional treatment has been shown to significantly benefit adults with AN, which ranks among the leading causes of disability and premature death in young women. The investigators propose to test the hypothesis that a novel, couple-based intervention developed for adult AN (UCAN) significantly enhances treatment outcome and reduces risk of relapse compared with treatment conducted entirely on an individual basis, the standard mode of treatment delivery in the community. The investigators plan to compare UCAN with individual treatment in a randomized controlled trial (RCT). All participants with AN will receive a common set of core interventions, including medical management, nutrition counseling, and a base level of individual cognitive-behavioral therapy (CBT), with randomization either to: 1) UCAN couple-based intervention or 2) a higher "dose" of individual CBT. The partners are involved in varying ways and to varying degrees in treatment. In addition, progress will be followed for one year after completion of active treatment.

Inclusion Criteria

1. Participant with AN must have:

   1. Current Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (Text Revision) (DSM-IV-TR) criteria for AN, restricting or binge/purge subtype; BMI between 15.0-19.0 currently or sometime in the past 3 months.
   2. Adequate insurance coverage to support a higher level of care including but not limited to partial hospitalization or inpatient treatment.

2. Both members of couple must be:

   1. At least 18 years of age.
   2. English speaking.
   3. Involved in a committed relationship for at least 6 months, regardless of sexual orientation.
   4. Wiling to participate in treatment.

Exclusion Criteria

1. Participant with AN cannot be: Unwilling to suspend other treatment for AN for the duration of the study.

2. Partner cannot meet: Current DSM-IV-TR criteria for AN, restricting or binge/purge subtype. We will exclude couples in which both partners have a diagnosis of AN.

3. Neither member of couple can have:

   1. Alcohol or drug dependence in the past year.
   2. Current significant suicidal ideation (from interview or depression assessment).
   3. Severe depression that would seriously interfere with functional capacity, as judged by the PIs or study physician.
   4. Developmental disability that would impair the ability to benefit from the intervention.
   5. Any psychosis, schizophrenia, or bipolar I disorder, unless stably remitted on maintenance therapy for at least 1 year.
   6. Moderate to high levels of physical violence from participant/partner as reported during baseline interview.
   7. Previously participated in the UCAN couple treatment condition in the preliminary couples treatment study (#07-1429. UCAN: Uniting Couples (in the treatment of) Anorexia Nervosa)