Treating bulimia nervosa in the context of gender dysphoria using 10‐session cognitive behavior therapy

Abstract

Objective This case report describes the psychological treatment for bulimia nervosa of a 16‐year old with co‐occurring gender dysphoria. He reported restricting his food intake and purging for approximately 1 year prior to therapy commencing. Method Ten sessions of cognitive behavioral therapy for eating disorders (CBT‐T) were conducted with accommodations for gender‐specific body dissatisfaction. Results The client eliminated binging and purging from the second treatment session and had maintained this at the 3‐month follow‐up. The quantity and variety of foods he was eating had increased and he no longer reported subjective binges. Improvements were also evident in his depression, anxiety and stress symptoms. Discussion This suggests that bulimia nervosa may be effectively treated with CBT‐T in the context of gender dysphoria. Further research that investigates the generalizability of these outcomes would be beneficial.

Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

“…Participants expressed that bodily discomfort related to gender requires intervention with gender‐affirming care and called for ED treatment to include coping skills to help bridge patients to such interventions and to support their living with ongoing gender dysphoria, as needed. This sentiment is also expressed in a published case study describing successful use of a CBT paradigm for bulimia nervosa treatment in a transgender adolescent (Cibich & Wade, 2019), in which authors specifically note that modifications were made to the treatment protocol to remove behavioral experiments that would challenge gender dysphoria and to include DBT and motivational interviewing techniques to support the patient in sitting with the discomfort around his bodily incongruence.…”

“…Current evidence-based treatments for EDs in adults consist predominantly of psychotherapy, specifically cognitive behavioral therapy (CBT) (Grenon et al, 2019) and cognitive behavioral therapy-enhanced for eating disorders (CBT-E) (Atwood & Friedman, 2020;Dalle Grave, 2012), which have robust data for treating multiple distinct eating disorders. However, these interventions were developed in exclusively cisgender patient populations (Burnette et al, 2022) and have not yet been systematically adapted to consider TNG-specific needs and preferences, though one published case study to date describes success of a targeted CBT for treating bulimia nervosa in a transgender adolescent (Cibich & Wade, 2019). Additionally, the efficacy studies predominantly included white participants and did not demonstrate intervention efficacy across socioeconomic statuses (Burnette et al, 2022).…”

A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders

“…There were no statistically significant differences in cost of treatment between the three treatment groups, though the CBT group was least expensive at non-significant level Fair a Charpentier et al (2003) [ 41 ] Cohort study AN BN 17.7 [13–22] Group CBT (26) 12 13 wks (≈ 3 mo) 3 mo For patients with BN, statistically significant reduction in ED psychopathology (EDI) and frequency of binges and purging at EOT, which was maintained at 3mo FU. For patients with AN, statistically significant increase in BMI, with no significant changes in other ED symptoms (EDI) Fair a Cibich and Wade (2019) [ 77 ] Case study BN 16 [N/A] CBT-T (1) N/A 10 sessions 3 mo Abstinence from binge eating and purging by second session, and ED psychopathology (EDE-Q) within community norm range by EOT. All changes maintained at 3mo FU Include b Cowdrey and Davis (2016) [ 78 ] Case study AN 15 [N/A] CBT-E (1) N/A 11 wks (≈ 3 mo) 8 mo Marked reduction in ED behaviors and "feeling fat" (self-monitoring records), global ED psychopathology (EDE-Q) within community norms, and clinically significant increases in weight at EOT.…”

Nursing Care Offered to A Teenager at Risk of Gender Dysphoria and Suicide: A Community Mental Health and Public Health Nursing Approach

“…In the literature, it has been stated that distorted body image and eating disorders are correlated in young people experiencing gender dysphoria (Milano et al, 2019;Cibich & Wade, 2019). It was reported in a study that as a result of interventions in two cases experiencing gender dysphoria and anorexia nervosa, psychological recovery was achieved, and nutritional behavior returned to normal (Ristori et al, 2019).…”