Academic journal article Journal of Counseling and Development : JCD

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self-Help Program for Mexican American Women with Binge Eating Disorders

Academic journal article Journal of Counseling and Development : JCD

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self-Help Program for Mexican American Women with Binge Eating Disorders

Article excerpt

Research has demonstrated that eating disorders such as bulimia nervosa and binge eating disorder (BED) occur in Mexican American women and pose serious mental and physical health risks (Cachelin, Phinney, Schug, & Striegel-Moore, 2006; Cachelin, Schug, Juarez, & Monreal, 2005; Cachelin, Veisel, Striegel-Moore, & Barzegarnazari, 2000). Bulimia is characterized by recurrent binge eating, inappropriate compensatory behavior, and overvaluation of body shape and weight (American Psychiatric Association [APA], 2000) and is associated with considerable psychiatric comorbidity and psychosocial problems. BED is defined by recurrent binge eating in the absence of inappropriate compensatory behaviors that are required for the diagnosis of bulimia. Additional BED criteria include the presence of at least three of five behavioral indicators of loss of control over binge eating (e.g., eating when not hungry, eating in secret), as well as distress over binge eating behavior (APA, 2000). As with bulimia, BED is associated with considerable medical and psychiatric comorbidity (Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009). Furthermore, obesity, which has been shown to contribute to hypertension, cardiovascular disease, and Type II diabetes as leading causes of death in the United States, is a major medical complication in BED (Marcus & Wildes, 2009; Wonderlich et al., 2009).

Recent studies suggest that lifetime prevalence estimates for bulimia and BED among Latinas ranged from 1.9% to 2.0% and from 2.3% to 2.7%, respectively (Alegria et al., 2007; Marques et al., 2010). These numbers are similar to those reported for the general population of U.S. females (Granillo, Jones-Rodriguez, & Carvajal, 2005). Latina women have reported less drive for thinness and consequently may be less likely to compensate for their eating binges than White women are (Marques et al., 2010). Obesity, which often accompanies BED, is recognized as a major health issue for Mexican Americans (Kuczmarski, Flegal, Campbell, & Johnson, 1994).

Despite their chronicity and severity, eating disorders largely go undetected and untreated (Becker, Hadley Arrindell, Perloe, Fay, & Striegel-Moore, 2010; Cachelin, Rebeck, Veisel, & Striegel-Moore, 2001; Cachelin, Striegel-Moore, & Regan, 2006). Although there is growing evidence of eating disorders as a health problem in Mexican and other Hispanic American women, these women are rarely seen in eating disorder clinics and are largely excluded from or underrepresented in treatment trials and research (Garvin & Striegel-Moore, 2001). In one study, Cachelin and Striegel-Moore (2006) found that fewer than 28% of a sample of Mexican American women with clinically significant eating disorders had ever sought treatment, and, of this group, only five women (6.6%) had actually received treatment. Of the few who do seek treatment, most turn to primary care physicians. Barriers reported by this group include feelings of shame, fear of stigmatization, believing that one should be able to help oneself, minimizing the eating problems, financial constraints, language barriers, limited knowledge of and access to health care services, and logistical challenges, such as long waits to see doctors and lack of child care (Cachelin et al., 2001; Cachelin & Striegel-Moore, 2006). Such findings underscore the great need in this population for accessible treatment.

* Overview of Cognitive Behavior Therapy and Guided Self-Help

Cognitive behavior therapy (CBT) is widely considered to be the treatment of choice for bulimia and BED (Wilson, Grilo, & Vitousek, 2007). According to the cognitive behavior model, the core psychopathology of binge eating is a negative overconcern with body shape and weight that leads to dysfunctional dieting and other unhealthy weight-control behaviors. The dysfunctional dieting, in turn, predisposes one to binge eating. CBT consists of cognitive and behavioral procedures designed to enhance motivation for change, replace dysfunctional dieting with a regular and flexible pattern of eating, decrease undue concern with body shape and weight, and prevent relapse. …

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