Mental Health Counseling Responses to Eating-Related Concerns in Young Adult Women: A Prevention and Treatment Continuum

Article excerpt

Because susceptibility for eating-related concerns exists along a continuum, this manuscript first introduces a framework for intervention that offers a continuum of responses for addressing such concerns in young adult women. The mental health strategies needed range from early identification and interventions for subthreshold problems to more advanced counseling approaches to address emerging and full eating concerns. It next discusses three different types of interventions." (a) preventive approaches for young women at risk," (b) intermediate approaches for women who demonstrate initial symptoms of disordered eating; and (c) psychotherapeutic interventions for women whose symptoms meet diagnostic criteria for eating disorders.

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Over the past decade health and mental health professionals have responded increasingly to gender-related mental health concerns (Arnstein, 1995; Carter & Parks, 1996; Choate, 2008), and the high incidence of eating-related difficulties in young adult women is well documented (Schwitzer, Hatfield, Jones, Duggan, Jurgens, & Winninger, 2008; Schwitzer, Rodriguez, Thomas, & Salimi, 2001). Eating disorders are among the 10 leading causes of psychological distress among young adult women (Mathers, Vos, Stevenson, & Begg, 2000). Although boys and men also experience eating-related problems (Ousley, Cordero, & White, 2008), they are far outnumbered by girls and women with such concerns (Hock, 2006; Wittichen & Jacobi, 2005). Further, although eating-related concerns historically have been associated with European and American girls and women, they now appear across ethnic populations (Becker, Franko, Speck, & Herzog, 2003; Cachelin & Striegel-Moore, 2006). Rich and Thomas (2008) recently found few differences in disordered eating among White, African American, and Latina women in college populations.

These findings are not surprising given current cultural standards regarding the importance of extreme thinness and beauty for women. In fact, previous authors agree that essentially all girls and women in the United States are to some extent pressured to achieve these standards (Peck & Lightsey, 2008; Striegel-Moore & Bulik, 2007). Although some are able to resist these pressures, roughly half of all young adult women develop some combination of the negative cognitive and affective symptoms that are characterized as body image dissatisfaction (BID). Women who experience BID often engage in excessive dieting and maladaptive eating practices. A minority of women who experience these initial characteristics later develop symptoms that meet the criteria for a diagnosable DSM-IV-TR eating disorder (American Psychiatric Association, 2000a): anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS).

Because eating-related concerns, BID symptoms, and diagnosable eating disorders all exist along a continuum (Stice, Killen, Hayward, & Taylor, 1998), the mental health strategies needed range from early identification and interventions for subthreshold problems to advanced counseling approaches that address emerging and fully existing disorders (Schwitzer et al., 2001; Striegel-Moore & Bulik, 2007). It is therefore important that mental health counselors possess the knowledge and skills to work effectively with women across the continuum. According to the mission statement of the American Mental Health Counselors Association (AMHCA), counselors should be highly skilled in both conducting psychoeducational and prevention programs and providing psychotherapy for resolving mental health problems (AMHCA, 2008). This manuscript therefore first introduces a framework for intervention that offers a continuum of responses for addressing eating concerns in young women and then discusses three types of interventions: (a) preventive approaches for young women at risk for BID; (b) intermediate approaches for women who exhibit initial disordered eating symptoms; and (c) psychotherapeutic interventions for women whose symptoms meet diagnostic criteria for eating disorders. …