By: Marisol Perez, Ph.D., FAED
In graduate school I wanted to study eating disorders among Black, Indigenous, and People of Color (BIPOC). I presented my idea during a “think tank” session, in which graduate students discussed research ideas and received feedback from faculty and other students. I recall feeling nervous standing in front of the group, but my nervousness quickly turned to shock when my audience dismissed the idea that individuals with a BIPOC identity could develop an eating disorder. I remember responding sarcastically, “I did not realize that our skin pigment, melanin, could protect us from psychiatric disorders.”
The response to my idea was not actually about melanin; it was an example of the stereotype that only White women develop eating disorders.
Twenty years later, I am delighted that scientists consistently recognize that individuals of any race, ethnicity, gender, and sexual orientation can develop an eating disorder. Based on prevalence rates of eating disorders among Black, Latinx and Asian American women, my research group estimates that over 2 million racial/ethnic minority women will struggle with an eating disorder during their lifetime in the U.S. (Perez et al., under review).
Though scientists know anyone can develop an eating disorder, this knowledge has not reached the general public. Society continues to have a narrow view of someone with an eating disorder: a White woman who is extremely thin and malnourished. Indeed, this is the image most often portrayed in the media.
This narrow view prevents detection of eating disorder symptoms, especially among individuals with BIPOC identities. More often than not, when we see individuals with BIPOC identities in mental health treatment it is for something other than an eating disorder. When we raise the possibility of an eating disorder, a common response is to dismiss the idea because of their BIPOC identity. My response is always the same, “Unfortunately, to the best of our knowledge, melanin – which determines skin color in our bodies – does not protect from an eating disorder.”
We have to explain that any individual, regardless of gender, size, weight, shape, or skin color, can develop an eating disorder. My experience shows that BIPOC families need time and psychoeducation to understand, and to change their perception of individuals with eating disorders. This is an important problem that we researchers need to address.
As a field, we need to do a better job of communicating to the general public that anyone can develop an eating disorder. The more knowledgeable society becomes, the better equipped parents, families, and friends can be at detecting symptoms of an eating disorder. Because BIPOC caregivers and family members often struggle to find support for eating disorders in their communities, a more knowledgeable society could also result in more help for these families. Advertising about the great communities of support (like F.E.A.S.T.) that exist for parents and families of those with eating disorders in community centers, medical facilities, and religious organizations that serve BIPOC families would be helpful.
We also need to re-examine the ways in which we assess and detect symptoms of eating disorders. Research from my lab highlights how BIPOC individuals can differ in presentation and symptoms. We summarize our clinical and research findings, highlighting the trends we see. It is important to clarify that individuals with BIPOC identities can present with any symptom. Indeed, we have seen every eating disorder symptom from the DSM 5 reported by individuals with BIPOC identities.
- The most prevalent eating disorder is Binge Eating Disorder followed by Bulimia Nervosa across all BIPOC groups. They can present with Anorexia Nervosa, but it is less prevalent.
- Black/African American, Hispanic/Latinx, and Asian American women report higher rates of vomiting than non-Hispanic White women.
- Asian American women report higher laxative misuse than any other group.
- Black/African American, Hispanic/Latinx, and Asian American women report less compulsive excessive exercising than non-Hispanic White women.
- Individuals with Black or African American identities tend to report weight concerns but not body shape concerns. They also report less drive for thinness.
- Hispanic/Latinx women tend to report striving for a body shape that is slender but curvy and not the ultra-thin ideal.
- Asian American women present with high levels social appearance anxiety that impacts their eating disorder symptoms.
These differences in symptoms are important, and because BIPOC individuals might present differently, treatments might work differently or not as well.
Our work, and the field in general, is limited by how eating disorder symptoms are assessed, which is based on our understanding of eating disorders in predominantly White, middle and upper-class women. As a field, we need to take a step back and invite individuals who have a BIPOC identity and an eating disorder, and their families, to determine their symptoms. We need to identify any symptoms we are not currently assessing, and we need to understand how symptoms vary among BIPOC individuals. Such research would improve assessments and better capture variations across individuals.
In the twenty years since I participated in the think tank session, the study of eating disorders has come a long way. I hope over the next twenty years we see an increase in public knowledge about eating disorders and better assessment and detection of eating disorders among individuals with BIPOC identities. I look forward to the day when I no longer have to inform people that the amount of melanin does not protect from developing an eating disorder.