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

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. © 2022 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.