A Relational‐Cultural Approach to Working With Clients With Eating Disorders

Eating disorders are believed to be among the most lethal mental health diagnoses, with some estimates suggesting that 10% of people with anorexia nervosa will eventually die from complications associated with the disorder (Academy for Eating Disorders, 2010). The criteria for anorexia nervosa and bulimia nervosa are outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association [APA], 2000). However, researchers have found that the symptoms experienced by most clients tend to fall under the eating disorders not otherwise specified diagnosis (Choate & Schwitzer, 2009; Schwitzer et al., 2008; Wilson, Grilo, & Vitousek, 2007). Some scholars have asserted that eating disorders have biological, sociological, and psychological origins, with the development and maintenance of eating disorders being linked to a variety of life experiences (Wilson et al., 2007). Some researchers have suggested that many people with eating disorders have suffered from various childhood traumas, including sexual abuse (Brewerton, 2007; Kong & Bernstein, 2009; Smolak & Murnen, 2002). Feminist interpretations of the origins of eating disorders focus on the contributions of gender roles; cultural variables; and issues of power, privilege, and marginalization in the development and maintenance of mental health concerns (Eriksen & Kress, 2008). As an outgrowth of feminist therapies, relational cultural theory (RCT) is a theoretical approach, which suggests that the need for connection and context, rather than individuation, is the foundation of development and is also central to understanding the disorders' etiology, maintenance, and treatment. RCT challenges traditional models of what growth looks like and has widespread implications for counselors' practice; its depathologizing perspective provides context to the many concerns that clients bring to counseling including issues of power, privilege, marginalization, stigmatization, belonging, and acceptance. Although relational approaches began by focusing on the unique psychological needs of women (Jordan, 2010), these approaches are now seen as increasingly relevant to male clients as well. RCT "hopes to better represent both women's and men's psychological experience as it seeks transformation of chronic disconnection into connection and empowerment of individuals of both genders and for society as a whole" (Jordan, 2010, p. 24). In this article, we provide an overview of eating disorders, followed by a brief discussion of the tenets of RCT. Finally, recommendations are presented for combining relationally focused counseling with evidence-based treatments for eating disorders via both prevention and individual counseling. * Prevalence of Eating Disorders A recent study on the prevalence of eating disorders reported that 0.9% of women and 0.3% of men reported having anorexia nervosa at some time in their lives, whereas 1.5% of women and 0.5% of men reported having bulimia nervosa (Hudsona, Hiripib, Pope, & Kessleb, 2007). Additionally, Hudsona et al. (2007) found that 0.5% of women and 2% of men reported having had binge eating disorder at some point in their lives. It is estimated that, at any given time, the number of girls and women reporting eating disorder symptoms may reach approximately 10% of the total population (APA, 2000). Although all individuals who have a complicated relationship with food may not meet the criteria for eating disorder diagnoses, their struggle with disordered eating is a real concern that may have an impact on their ability to function and may lead them to seek counseling (Academy for Eating Disorders, 2010). Historically, it was thought that rates of eating disorders were consistent among women in Western populations and that those in non-Western communities had far fewer incidences of these disorders. However, recent studies suggest that women of color are just as susceptible to eating disorders as their White counterparts are (Becker, Franko, Speck, & Herzog, 2003; Chamorro & Flores-Ortiz, 2000; Erickson & Gerstle, 2007). …