Abstract
Bulimia nervosa (BN) has becoming an increasingly common form of eating disorder, particularly with gay and lesbian populations. The lack of current literature on this particular topic, as well as the limited resources for recommendations of treatment adaptations for this population is evident by the disproportionate number of sexual minorities that present for treatment. This paper discusses the possible reasons for the lack of literature and resources, and provides clinicians with the adaptations of Emotion Focused Therapy, Cognitive Behavioral Therapy, Structural Family Therapy, and Internal Family Systems when working with lesbian and gay populations who are suffering from BN. This paper aims to contribute more to the limited research in the area of sexual minorities in hopes to broaden the understanding of the treatment of individuals, as well as family functioning. We attempt to adapt these therapy modalities to be more inclusive of these nuanced presenting concerns, and to provide clinicians from all scopes of practice a thorough look into the treatment of a sexual minority population.
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References
Beck, J. S., & Beck, A. T. (2011). Cognitive behavior therapy: Basics and beyond. New York: The Guilford Press.
Blank, T. O., Descartes, L., & Ascenio, M. (2012). Issues in the health of lesbian, gay, bisexual, and transgender people in couple and family therapy. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBT-affirmative couple and family therapy. New York: Routledge Taylor & Francis Group.
Bonvicini, K. A., & Perlin, M. J. (2003). The same but different: Clinician–patient communication with gay and lesbian patients. Patient Education and Counseling, 51(2), 115–122. doi:10.1016/s0738-3991(02)00189-1.
Bramon-Bosch, E., Troop, N. A., & Treasure, J. L. (2000). Eating disorders in males: A comparison with female patients. European Eating Disorders Review, 8, 321–328. doi:10.1002/1099-0968(200008)8:4<321::AID-ERV355>3.0.CO;2-G.
Brown, L. (1987). Lesbians, weight and eating: New analyses and perspectives. In Lesbian Psychologies Collective, Boston (Ed.), Lesbian psychologies: Explorations and challenges (pp. 294–309). Chicago: University of Illinois Press. doi:10.1037/028316.
Brown, T. A., & Keel, P. K. (2012). The impact of relationships on the association between sexual orientation and disordered eating in men. International Journal of Eating Disorders, 45, 792–799. doi:10.1002/eat.22013.
Bydlowski, S., Corcos, M., Jeammet, P., Paterniti, S., Berthoz, S., Laurier, C., Chambry, J., & Consoli, S. M. (2005) Emotion-processing deficits in eating disorders. International Journal of Eating Disorders, 37(4), 321–329.
Carlat, D. J., Camargo, C. A., Jr., & Herzog, D. B. (1997). Eating disorders in males: A report on 135 patients. American Journal of Psychiatry, 154, 1127–1132. doi:10.1176/ajp.154.8.1127.
Carper, T. L., Negy, C., & Tantleff-Dunn, S. (2010). Relations among media influence, body image, eating concerns, and sexual orientation in men: a preliminary investigation. Body Image, 7, 301–309. doi:10.1016/j.bodyim.2010.07.002.
Cooper, M. J., Todd, G., & Wells, A. (1998). Content, origins, and consequences of dysfunctional beliefs in anorexia nervosa and bulimia nervosa. Journal of Cognitive Psychotherapy, 12(3), 213–230.
Cooper, M. J., Wells, A., & Todd, G. (2004). A cognitive model of bulimia nervosa. British Journal of Clinical Psychology, 43, 1–16. doi:10.1348/014466504772812931.
D’Aniello, C. (2013). Contemporary MFT models’ alignment with relational common factors. Contemporary Family Therapy: An International Journal, 35(4), 673–683. doi:10.1007/s10591-013-9260-8.
Dolhanty, J., & Greenberg, L. S. (2007). Emotion-focused therapy in the treatment of eating disorders. European Psychotherapy, 7(1), 97–116.
Dworkin, S. H. (1989). Not in man’s image: Lesbians and the cultural oppression of body image. Women and Therapy, 8, 27–39. doi:10.1300/J015v08n01_03.
Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. American Psychological Association.
Feldman, M. B., & Meyer, I. H. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3), 218–226. doi:10.1002/eat.20360.
Feldman, M. B., & Meyer, I. H. (2010). Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals. Psychiatry Research, 180, 126–131. doi:10.1016/j.psychres.2009.10.013.
Gehart, D. R. (2014). Mastering competencies in family therapy: A practical approach to theory and clinical case documentation. Belmont, CA: Brooks/Cole Pub. doi:10.1111/j.1752-0606.2011.00267_1.x.
Glasofer, D. R., & Devlin, M. J. (2013). Cognitive behavioral therapy for bulimia nervosa. Psychotherapy, 50(4), 537–542. doi:10.1037/a0031939.
Greenan, D. E., & Tunnell, G. (2003). Couple therapy with gay men. New York: The Guilford Press. doi:10.5860/choice.40-4917.
Greenberg, L. S., & Watson, J. C. (1998). Experiential therapy of depression: Differential effects of client-centered relationship conditions and process experiential interventions. Psychotherapy Research, 8, 210–224. doi:10.1080/10503309812331332317.
Grilo, C., & Mitchell, J. E. (2010). The treatment of eating disorders: A clinical handbook. New York: Guilford Press.
Herzog, D. B., Norman, D. K., Gordon, C., & Pepose, M. (1984). Sexual conflict and eating disorders in 27 males. The American Jouranal of Psychiatry, 141, 989–990. doi:10.1176/ajp.141.8.989.
Ivanova, I. (2013). The “how” of change in emotion-focused group therapy for eating disorders. Unpublished doctoral dissertation. University of Toronto T Space. http://hdl.handle.net/1807/43601.
Ivanova, I., & Watson, J. (2014). Emotion-focused therapy for eating disorders: Enhancing emotional processing. Person-Centered and Experiential Psychotherapies, 13(4), 278–293. doi:10.1080/14779757.2014.910132.
Johnson, S. M., & Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. New York: Brunner-Routledge.
Lampard, A. M., & Sharbanee, J. M. (2015). The cognitive-behavioural theory and treatment of bulimia nervosa: An examination of treatment mechanisms and future directions. Australian Psychologist, 50(1), 6–13. doi:10.1111/ap.12078.
Laska, M. N., VanKim, N. A., Erickson, D. J., Lust, K., Eisenberg, M. E., & Rosser, B. R. S. (2015). Disparities in weight and weight behaviors by sexual orientation in college students. American Journal of Public Health, 105, 111–121. doi:10.2105/AJPH.2014.302094.
Latzer, Y., Hochdorf, Z., Bachar, E., & Canetti, L. (2002). Attachment style and family functioning as discriminating factors in eating disorders. Contemporary Family Therapy: An International Journal, 24(4), 581. doi:10.1023/A:1021273129664.
Le Grange, D., & Lock, J. (2010). Family-based treatments for adolescents with bulimia nervosa. In C. Grilo & J. Mitchell (Eds.), The treatment of eating disorders: A clinical handbook (pp. 372–387). New York: Guilford.
Martins, Y., Tiggemann, M., & Kirkbride, A. (2007). Those speedos become them: The role of self-objectification in gay and heterosexual men’s body image. Personality and Social Psychological Bulletin, 33, 634–647. doi:10.1177/0146167206297403.
Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press.
Minuchin, S., Rosman, B., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. Cambridge: Harvard University Press.
Pachankis, J. E., & Bernstein, L. B. (2012). An etiological model of anxiety in young gay men: From early stress to public self-consciousness. Psychology of Men & Masculinity, 13(2), 107–122. doi:10.1037/a0024594.
Prouty, A. M., & Protinsky, H. O. (2002). Feminist-informed internal family systems therapy with couples. Journal of Couple & Relationship Therapy, 1(3), 21–36. doi:10.1300/j398v01n03_02.
Rogers, C. (1965). Client-centered therapy, Ch. 11 (pp. 481–533). Boston, MA: Houghton Mifflin Company.
Russell, G. F., Szmukler, G. I., Dare, C., & Eisler, I. (1987). An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 44(12), 1047–1056. doi:10.1001/archpsyc.1987.01800240021004.
Schwartz, R. C. (1982). Bulimia and family therapy: A case study. International Journal of Eating Disorders, 2(1), 75–82. doi:10.1002/1098-108X(198223)2:1<75::AID-EAT2260020109>3.0.CO;2-A.
Schwartz, R. C. (1987). Our multiple selves. Family Therapy Networker, 11, 25–31, 80–83.
Schwartz, R. C. (1995). Internal family systems therapy. New York: Guilford Press.
Schwartz, R. C. (2013). Moving from acceptance toward transformation with internal family systems therapy (IFS). Journal of Clinical Psychology, 69(8), 805–816.
Schwartz, R. C., Barrett, M. J., & Saba, G. (1985). Family Therapy for Bulimia. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of Psychotherapy for anorexia nervosa & bulimia (pp. 280–310). New York, NY: Guilford Press.
Tweed, S. (2013). Group-based Emotion-Focused Therapy (EFT) for women with eating disorders in an outpatient setting. Unpublished doctoral dissertation. Toronto: York University.
Waller, G., Gray, E., Hinrichsen, H., Mountford, V., Lawson, R., & Patient, E. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings. International Journal of Eating Disorders, 47(1), 13–17. doi:10.1002/eat.22181.
Waller, G., Kennerley, H., & Ohanian, V. (2007). Schema-focused cognitive-behavioral therapy for eating disorders. In L. P. Riso, P. L. du Toit, D. J. Stein, & J. E. Young (Eds.), Cognitive schemas and core beliefs in psychological problems: A scientist-practitioner guide (pp. 139–175). Washington, DC: American Psychological Association.
Waller, G., Stringer, H., & Meyer, C. (2012). What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders? Journal of Consulting and Clinical Psychology, 80(1), 171–175. doi:10.1037/a0026559.
Watson, J. C. (2002). Revisioning empathy: Research, practice and theory. In D. Chain (Ed.), Handbook of research and practice in humanistic psychotherapies (pp. 445–471). Washington, DC: APA Books.
Wnuk, S. (2011). Treatment development and evaluation of emotion-focused group therapy for women with symptoms of bulimia nervosa. Doctoral dissertation. Library and Archives Canada.
Zuccarini, D., & Karos, L. (2011). Emotionally focused therapy for gay and lesbian couples: Strong identities, strong bonds. In J. L. Furrow, S. M. Johnson, & B. A. Bradley (Eds.), The emotionally focused casebook: New directions in treating couples (pp. 317–342). New York: Routledge/Taylor & Francis Group. doi:10.4324/9780203818046.
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Minaiy, C., Johnson, N., Ciochon, T. et al. Adaptability of Family Therapy Modalities in the Treatment of Lesbian and Gay Clients with Bulimia Nervosa. Contemp Fam Ther 39, 121–131 (2017). https://doi.org/10.1007/s10591-017-9410-5
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DOI: https://doi.org/10.1007/s10591-017-9410-5