Many patients with severe and enduring anorexia nervosa eventually develop an aversion to food, worsening resistance to treat. Patients may feel afraid of or disgusted by food due to developmental experiences such as bullying, but food aversion can also be worsened iatrogenically through traumatic or punitive feeding experiences that damage therapeutic relationships, such as restrained nasogastric feeding. Individuals with anorexia nervosa often have reduced capability for extinction of fear learning but increased fear generalization and reinstatement, especially among patients with comorbid depression. While exposure therapy is the standard for improving fear learning extinction, it can be problematic for anorexia nervosa patients as refeeding often entails weight gain, fluid shifts, and metabolic instability that may further reinforce the disorder's cognitions. Furthermore, the chronic stress of anorexia nervosa can reduce neurogenesis and therefore also reduce the efficacy of exposure treatments. Other treatments and supplementary measures for fear extinction are being explored, such as positive mood induction, cycloserine to consolidate learning, virtual reality therapy, cognitive remediation approaches that foster big-picture thinking, cognitive skills training for social avoidance, go/no-go inhibition training (especially for binge-purge subtypes), and food-related attention bias modification training.