Counseling a Biracial Female College Student with an Eating Disorder: A Case Study Applying an Integrative Biopsychosocialcultural Perspective

This case study describes short-term counseling with a young biracial woman experiencing an eating disorder. A biopsychosocialcultural conceptualization of the problem is described. The counseling approach is informed by feminist and multicultural theory and uses both interpersonal and cognitive behavior therapy. ********** The abilities to effectively assess and treat dysfunctional eating and weight management behaviors, distressing body dissatisfaction, and diagnosable eating disorders (EDs) are essential skills for campus counseling professionals who work with female student clients (Huebner et al., 2006). Because EDs typically begin in adolescence, college women often bring established eating concerns with them to campus or begin to experience them once they arrive; furthermore, EDs often co-occur with other serious mental health concerns such as mood and anxiety disorders and, in their most serious forms, can lead to self-injury, suicidal situations, or medical complications (Hotelling, 2001). Although certain EDs also are common in men, 90% of individuals with EDs are women (American Psychiatric Association [APA], 2000). Three major categories of diagnosable EDs currently are recognized (APA, 2000). Anorexia is characterized by a refusal to maintain minimally normal body weight and intense fear of becoming fat. Bulimia is characterized by out-of-control eating in the form of bingeing episodes along with compensating for overeating via vomiting, severe dieting, laxative use, or overexercise. Eating Disorder Not Otherwise Specified (EDNOS) is usually characterized by self-evaluation that is unduly influenced by body considerations, intense fear of gaining weight, disturbance in body image, severe dieting, bingeing, and compensatory behavior that is less than the specific duration, frequency, or severity thresholds for anorexia or bulimia (APA, 2000). By far, EDNOS and diagnostically subclinical eating-related concerns constitute the largest group of eating issues experienced by college women; in fact, although anorexia and bulimia are relatively rare (0.5% to 3.0%), Mulholland and Mintz (2001) found that up to 5% of college women experience EDNOS and 19 to 32% deal with subclinical eating-related problems. These types of problems exist along a continuum. For example, Keel, Heatherton, Dorer, Joiner, and Zalta (2006) reported that although the rate of fully diagnosable bulimia among college students has decreased over the last 20 years, the dangerous practice of purging has not decreased. Furthermore, body dissatisfaction alone can create distress and is a principal risk factor for EDs (Choate, 2005). Correspondingly, although treatment of full-syndrome EDs is important, counselors must prepare for the greater numbers of college women experiencing some form of EDNOS (Schwitzer et al., 2008) or other subclinical eating and body image disturbance (Celio et al., 2006; Luce, Crowther, & Pole, 2008). Understanding ED Behavior Most experts agree that multiple etiological factors (such as societal pressures, family dysfunction, individual vulnerability, genetics, and trauma) lead to EDs; however, how these factors relate to one another, or combine uniquely in specific individuals, is not yet fully understood (Striegel-Moore & Cachelin, 2001). I believe Connors' s (1996) risk factor model, one of the early risk factor models, is especially helpful for its scope and parsimony (see Figure 1). Connors proposed that known risk factors lead to two central domains, body dissatisfaction and self-regulatory difficulties, and that the severity of these two domains and their potential merging is what leads to normative discontent (the term coined by Rodin, Silberstein, & Striegel-Moore, as cited in Connors, 1996, p. 286), to subclinical or full EDs, or to an unrelated problem. When control of one's own body is adopted as a solution to low self-esteem, interpersonal problems, or mood difficulties, an ED seems more likely. …