Chapter 6: Assessment and Treatment of Bulimia Nervosa: Case Examination of a Bisexual, Nonbinary Hispanic Individual

This chapter provides a brief overview of the prevalence rates of bulimia nervosa (BN) within the United States population in general, and across gender, race, ethnicity, sexual orientation, and age. Using the American Psychological Association Division 12’s guidelines for empirically-supported treatments, cognitive behavioral therapy, interpersonal therapy, and family therapy for bulimia nervosa are discussed. The empirical literature on treatment adaptation due to social identities is reviewed, although it is sparse. A case study of a patient with intersecting social identities, including Hispanic, bisexual, and nonbinary, is presented and discussed in terms of assessment and treatment.

BN is an eating disorder associated with serious medical and psychological issues. Medical complications from BN include, but are not limited to, dental issues, gastro-intestinal problems, and nutritional abnormalities (Mehler, 2011). Further, BN has been associated with depression, anxiety, post-traumatic stress, and substance use disorders (Udo & Grilo, 2019) as well as suicidal ideation, attempts, and completion (Bodell et al., 2013). BN can lead to significant disability and impairment (Udo & Grilo, 2019). The prevention and treatment of BN is an important societal issue, as total economic costs associated with eating disorders in the U.S. were estimated to be $59.9 billion in 2018-2019 alone (Deloitte Access Economics, 2020).