An Examination of Anorexia Nervosa in Black Women
by Dani Coan
Dani is a rising senior social work major at NC State and a CEED Summer Intern. She is also a Research Assistant in Dr. Goode’s Living F.R.E.E. Lab
Black women represent 6.4 percent of the U.S. population. Managing the interlocking impacts of racism and sexism is a core theme in their daily lives. They face many different stressors that create negative impacts on their mental health and self-identity. In a 2010 study, the sense of being overwhelmed in terms of balancing everything emotionally, with relationships, work, and family was a common theme, as well as feeling isolated from white society and pressured to prove themselves in white dominated spaces (Everett, 2010).
Black women also face stressors associated with body image and social pressures in American, western society. Many popular theories propose Black women are protected from body dissatisfaction and have higher body-esteem because of “Black culture.” However, Poran (2006) reported that Black women feel pressure to be thin, competition with other Black women in the realm of beauty, and a strong sense of being misrepresented by media images of thin Black women. Black women did not feel protected by Black culture and discussed the constant pressure from white beauty standards.
According to the DSM-5, anorexia nervosa (AN) is characterized by severely low body weight (American Psychiatric Association, 2013). Because of this criterion, people who exhibit all of the characteristics of the eating disorder (food restriction, fear of gaining weight, weight loss), but are not underweight, are not classified as having AN, and are therefore less likely to be referred to or receive specialized treatment. Black women have higher bone densities and higher muscle mass than white women, meaning that it is far less likely for them to be underweight (Endocrine Society, 2009). However, barring the DSM-5 low weight criterion, there is ample evidence of AN occurring in Black women (especially adolescents).
In a study done in 1991 on Black, low-income adolescents, 12 percent thought they might have an eating disorder and reported behaviors similar to individuals with eating disorders. However, most students with or without a self-reported eating disorder were within their expected weight range. Negative food attitudes of students with self-reported AN were common, with these students also sharing the common risk factor traits of high parental and cultural expectations, perfectionism, anxiety, and a fear of being ‘ineffective’. These students also reported the frequent use of fasting and restriction as methods of weight reduction.Most students (with or without a self-reported eating disorder) also cited dissatisfaction with body weight and appearance and fear of obesity as primary concerns/sources of worry (Balentine 1991).
As early as 1984, Sibler reported two case studies of Black adolescent women who met the weight criteria for AN. Like the Balentine study, these cases also highlighted high levels of anxiety, intrusive thoughts, and a fear of obesity as common characteristics.
Even though Black adolescents are at serious risk, these two early reports offer recommendations for decreasing the vulnerability of these women. In addition, patients with AN cited supportive nonfamilial relationships, therapy, and maturation as the most significant factors contributing to their recovery (Tozzi, 2002). Since African American communities have been found to have more strong, supportive, community relationships than white communities, this is a promising factor that could be leveraged. However, Black women’s reluctance to ask for help or seek therapy is a hinderance to recovery. This reluctance to seek help is exacerbated by the failure of the healthcare community to recognize, diagnose, and refer Black women for specialized eating disorder treatment. Normalizing psychotherapy in Black communities, and “reframing strength as being able to ask for help instead of suffering in silence” could be extremely helpful in getting Black individuals with eating disorders the help that they deserve. In the eating disorder field, changing the DSM criteria for AN to ensure inclusivity, and creating more diverse, culturally competent prevention and treatment interventions would benefit not only Black women, but society as a whole.
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