The significance of the father-daughter relationship to understanding and treating Bulimia Nervosa: a Hermeneutic Phenomenological Study

Abstract

Bulimia nervosa (BN) is a highly researched eating disorder, yet real world recovery rates remain poor and incidence continues to rise. This study provides a focused exploration of the father-daughter relationship where BN emerges, in order to explore this relationship’s significance to the aetiology of BN and to BN’s resistance to CBT-based treatment. A hermeneutic phenomenological study of six women in recovery from BN was undertaken. Unstructured interviewing gathered detail-rich information, which was interpreted using the hermeneutic phenomenological method of multiple-level repeated readings, thematic comparisons and contextualisation. Findings were confirmed and validated using the hermeneutic circle and peer consultation. Fathers of daughters with BN were found to be a source of fear, control, abuse, emotional and physical avoidance and gender diminishment. This was a key source of complex traumatic experience in the family setting, with BN emerging in daughters to provide distraction and soothing. Furthermore, BN acts as a survival mechanism from early childhood and is a logical embodied response to the lived experience of complex trauma. The presence of trauma in the aetiology of BN, makes sense of why cognitive-based therapeutic protocols provide for limited treatment success. The research suggests greater potential lies in adopting the individualised, multi-modal complex trauma treatment model for BN, as this more appropriately addresses outcomes of relationship trauma.

Keywords:

• Bulimia nervosa
• father-daughter relationship
• complex trauma
• hermeneutic
• treatment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data is not publicly available due to the protection of confidentiality for participants, but in parts may be shared by the corresponding author on reasonable request.https://doi.org./10.1080/23311908.2022.2095721

Ethical approval

Ethical approval for this research was granted by the Torrens University Australia Human Research Ethics Committee. HREC ref no: H3/18.

Consent

Informed consent for the research was obtained from all participants.

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

A. J. Saunokonoko

Dr Antonia Saunokonoko is a psychotherapist working in private practice in Sydney, Australia. She specialises in helping people recover from eating disorders and all substance and behavioural addictions. Her research has focused on the condition of bulimia nervosa; exploring its relationship to complex trauma, family relationships and treatment options. Antonia has written Masters courses in psychotherapy and continues to contribute to the field by authoring articles for peer reviewed and mainstream publications.

M. Mars

Associate Professor Michelle Mars is a Psychotherapist and Social Scientist at Torrens University. Her research interests are mental health, gender and sexuality and wellbeing. Michelle worked for 10 years as a lecturer and senior lecturer at Massey University in New Zealand, and subsequently as researcher at Victoria University of Wellington, before coming to Australia.In the course of her career she has worked in the public private and not for profit sectors in the areas of mental health and with people with disabilities. Michelle’s publications include academic journals, book chapters, and creative works. She also publishes in the mainstream media.

W. J. Sattmann-Frese

Dr Werner Sattmann-Frese is schooled in both conventional medicine and body-oriented psychotherapy. He works in Sydney, Australia as a psychotherapist, specialising in ecologically aware counselling. He also trains students in psychosomatic medicine, psychotherapy and holistic bodywork. He is interested in the relationship between personal, social and environmental sustainability and has published in the area of learning for sustainable living, as well as developing an online learning programme for professionals.