by Susana Cruz García

Susana is a rising second year clinical psychology PhD student at the University at Albany studying eating disorders and a CEED Summer Fellow. (En español, haga clic aqui)

Eating disorders (EDs) affect people of all ages, sexes, races, ethnicities, sexual orientations, and socioeconomic statuses [1]. Despite previous research demonstrating that Latinx (gender-neutral pronoun) individuals have similar prevalence of EDs and their symptoms than non-Hispanic Whites [2,3], most current treatments and interventions lack adequate cultural sensitivity. A large epidemiological study conducted in the U.S. revealed that bulimia nervosa (BN; 0.14%) and binge-eating disorder (BED; 0.40%) are the most prevalent EDs seen in Hispanics [3]. Unfortunately, cultural (e.g., language), system-based (e.g., health care access) and structural (e.g., transportation) barriers to treatment prevent Latinas [4] and other racial/ethnic minorities [5,6], who are suffering from an ED, from seeking and accessing mental health services.

Family involvement in ED treatment among Latinas

Important efforts have emerged to integrate cultural values in order to provide culturally sensitive evidence-based treatment for EDs in diverse populations. Particularly, in the Latin American culture, family plays a central role [7]. Case and qualitative studies have explored family involvement in the treatment of Latinas with EDs as a way to increase adherence and retention. In general, those studies have found that some form of family intervention can be beneficial when working with Latinas [8,9,10].

Recently, researchers from the Center of Excellence for Eating Disorders (CEED) published a community-based study [11]. This study, conducted with low-acculturated Latinas with binge-spectrum EDs (e.g., BN, BED), found that treatment adherence and retention improved after incorporating a family member into cognitive-behavior therapy (CBT). The 25 adult participants were randomly assigned to two groups: culturally tailored individual CBT and CBT plus family enhanced (CBT+FE). Since caregiver burden has been reported in close relatives of individuals with an ED, psychoeducation, support, and coping resources to family members were offered in the family enhanced modules [11]. Variables of interest (e.g., treatment feasibility, acceptability, ED symptoms) were assessed throughout 25 sessions at the beginning of treatment, during treatment, at the end of treatment, and 3 months post-treatment.

Findings suggest that family-enhanced CBT in Latinas with EDs favored retention and adherence to treatment, which is fundamental considering that it has been noted that Latinx are more likely to drop out of treatment than non-Hispanic whites [12]. Additionally, the researchers found that therapeutic alliance and treatment satisfaction was favorably rated by both groups. Contrary to expectations, patients in the individual CBT group reported less ED symptomology and increased symptom improvement at 3-month follow-up compared with CBT+FE patients.

Future directions

This proof-of-principle study signals an important step forward in reducing system-based barriers to treatment by using a community-based approach. Providing training to community therapists on evidence-based treatment for EDs can help to make treatment more accessible for Latinxs. This study shows that CBT for binge-spectrum EDs is adequate for Latinas, and interventions for individuals with EDs and their symptoms may be beneficial to all parties involved. For example, relatives/partners can obtain a better understanding about what the ED is and how to support loved ones, and patients can feel supported and accountable during the treatment process. Certainly, additional research is needed. These findings have limited generalizability due to the small sample size and only female participants. Other future directions will explore how these results can apply to Latino males. Even with these limitations, this study provides valuable information that can implemented to achieve treatment retention and adherence in Latina patients.

Available resources in Spanish to learn more about EDs and how to offer support to loved ones:

Manual de los Trastornos de la Conducta Alimentaria

National Eating Disorders Association en español

Apoyo a ser queridos

Visit our website:

Eating Disorders Genetics Initiative en español

References

1. Academy for Eating Disorders. Press release. AED releases nine truths about eating disorders. Available from https://www.aedweb.org/publications/nine-truths
2. Perez, M., Ohrt, T. K., & Hoek, H. W. (2016). Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States. Current opinion in psychiatry, 29(6), 378-382.
3. Udo, T., & Grilo, C. M. (2018). Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of US adults. Biological psychiatry, 84(5), 345-354.
4. Reyes-Rodríguez, M. L., Ramírez, J., Davis, K., Patrice, K., & Bulik, C. M. (2013). Exploring barriers and facilitators in eating disorders treatment among Latinas in the United States. Journal of Latina/o psychology, 1(2), 112.
5. Cachelin, F. M., Rebeck, R., Veisel, C., & Striegel‐Moore, R. H. (2001). Barriers to treatment for eating disorders among ethnically diverse women. International Journal of Eating Disorders, 30(3), 269-278.
6. Innes, N. T., Clough, B. A., & Casey, L. M. (2017). Assessing treatment barriers in eating disorders: A systematic review. Eating disorders, 25(1), 1-21.
7. Campos, B., Ullman, J. B., Aguilera, A., & Dunkel Schetter, C. (2014). Familism and psychological health: the intervening role of closeness and social support. Cultural diversity & ethnic minority psychology, 20(2), 191–201.
8. Reyes-Rodríguez, M. L., Bulik, C. M., Hamer, R. M., & Baucom, D. H. (2013). Promoviendo una Alimentación Saludable (PAS) design and methods: Engaging Latino families in eating disorder treatment. Contemporary Clinical Trials, 35, 52–61.
9. Reyes-Rodríguez, M. L., Watson, H. J., Barrio, C., Baucom, D. H., Silva, Y., Luna-Reyes, K. L., & Bulik, C. M. (2019). Family involvement in eating disorder treatment among Latinas. Eating disorders, 27(2), 205-229.
10. Shea, M., Cachelin, F. M., Gutierrez, G., Wang, S., & Phimphasone, P. (2016). Mexican American women’s perspectives on a culturally adapted cognitive-behavioral therapy guided self-help program for binge eating. Psychological services, 13(1), 31–41.
11. Reyes-Rodríguez, M. L., Watson, H. J., Smith, T. W., Baucom, D. H., & Bulik, C. M. (2021). Promoviendo una Alimentación Saludable (PAS) results: Engaging Latino families in eating disorder treatment. Eating Behaviors, 101534.
12. Olfson, M., Mojtabai, R., Sampson, N. A., Hwang, I., Druss, B., Wang, P. S., … & Kessler, R. C. (2009). Dropout from outpatient mental health care in the United States. Psychiatric Services, 60(7), 898-907.