Have you ever thought about the relationship between eating disorders and ethnicity? In order to point out how stereotypes affect our understanding of eating disorders, Elaheh Nozari poses the following scenario: You walk past two women on the street. Both are tiny, but one is Caucasian and the other is Asian. You’re told that one of them is anorexic and the other is naturally thin. Which one has the eating disorder?
This is meant to highlight two stereotypes: one that classifies eating disorders as a white female problem and the other that lumps together Asian cultures and collectively labeling them as thin.
Sociocultural factors not only contribute to the development of eating disorders; they are also responsible for the stereotypes about them. Both of these barriers affect the research surrounding the underlying mental health issues and the pathways to their treatment.
For example, culture can put a premium on thin or thick physical appearances, or attach a deeper meaning to the preparation, consumption and sharing of food. In some households, consuming whatever is offered is interpreted as a sign of respect, even if that means accepting thirds or fourths. In these settings, binge eating or purging, might be overlooked and go untreated.
As Jiang points out in Diaspora and Disordered Eating, “In Chinese culture, food is often closely and inextricably tied to family dynamics and social hierarchies; an aversion to food has much broader social and familial implications beyond a personal experience of mental illness…Families could interpret disordered eating as a lack of affection or respect, adding to family dysfunction. If individuals experience heavy stress from their families and want to distance themselves as much as possible, food restriction may be an obvious way to do so, given the central nature of food preparation and eating to Chinese family life (Ma, 2009).”
Eating disorders in diasporas (a group of people who have emigrated and are now living within another country or culture) can be complex to diagnose and treat, highlighting the complicated intersectionality of culture, food and perceptions of mental illness.
Diasporas consist of immigrant parents and their children, both of whom are both living between two cultures in varying degrees. While parents may be more resistant to adopting aspects of their host cultures, their children often times have a more difficult time navigating between tradition/their parent’s way of life and Western culture, and it’s likely that they experience confusing and conflicting messages about food and weight.
Additionally, it may be difficult for first generation children to receive the emotional support they need from their immigrant parents due to this cultural gap between them. Although not all Asian Americans have the same experiences, immigration and assimilation require a negotiation of norms and identity which can make it difficult to detect, diagnose and treat an eating disorder.
Creating awareness about eating disorders and ethnicity, particularly among minority groups within the US, increases the likelihood that those who are suffering will seek help – or at least be aware of the pathways to treatment that exist.
Researchers from California State University, Fullerton (CSUF) have pointed to a lack of data surrounding eating disorders among Asian Americans as a main barrier to raising awareness. “Research has indicated that Asian Americans have stigma (negative views and beliefs) about seeking treatment, but we don’t know a lot about their subjective, phenological experiences of how they understand the reasons that stopped them from seeking treatments or stopped treatment.”
By researching and better understanding the obstacles to treatment among these populations, we can work to reduce these barriers and make both treatment and recovery more accessible.
In order to better serve minority ethnic groups or immigrant communities, professionals should be trained in cultural competency, incorporate cultural sensitivity into their work and familiar with the world views, values and beliefs of the populations they are working with. Additionally, therapy should be conducted with an understanding of cultural context and the stresses that come along with immigration and assimilation.
Here are some resources for clinicians to introduce them to topics in cross-cultural therapy and broaden their awareness about eating disorders among various ethnic groups:
Culturally Sensitive Therapy
Cross-Cultural Barriers to Mental Health Services in the United States
Providing Therapy Across Different Cultures
The Impact of Racial Stereotypes on Eating Disorder Recognition
Eating Disorders and Minorities
Eating Disorders in Spanish Cultures: Identification and Treatment
Prevalence and Treatment of Eating Disorders Among Hispanics/Latino Americans in the United States
African-Americans and Eating Disorders
The Truth About Asian Women and Eating Disorders
Diaspora and Disordered Eating
Teen Ties Her Eating Disorder to Cultural Identity
Jerica Rossi is a Marketing & Marketing Associate of PIMSY EHR. For more information about electronic solutions for your practice, check out Behavioral Health EHR.