Expanding our Potential for Healing from Eating Disorders through Diversity of Perspectives and Lived Experiences
"A Hunger So Wide and So Deep, by Becky W. Thompson. To say that this book resonated with me doesn't even capture what happened. It did more. Reading those stories, I felt seen, validated and soothed... and it was everything to me. "
The first time I read about queer women and women of color with eating disorders was in 1995. I was in grad school, interning at an eating disorder clinic, and a friend of mine who knew I was a biracial queer woman who had battled anorexia recommended the book A Hunger So Wide and So Deep, by Becky W. Thompson. To say that this book resonated with me doesn't even capture what happened. It did more. Reading those stories, I felt seen, validated and soothed... and it was everything to me.
The book is centered around the testimonials of queer women and women of color and their personal experiences with eating disorders. Their stories describe how parents and families who immigrate are responding to racism through anti-fatness. They identify the same confusion and mixed-messaging that I had received as a young person growing up in a biracial household. This book goes beyond the mainstream idea that eating disorders mostly happen to white, hetero, affluent, cisgender, able-bodied, neurotypical girls and integrates the impact of racism and oppression on eating disorders.
Until that point, I truly felt that there was something wrong with me and that my eating disorder made no sense. All of the biographies and textbooks that I had read about eating disorders had not in any way mirrored my own experience. As I read the stories in Thompson's book, it made me see that my story was true and valid. I realized that peoplecould understand, and peopledo understand because they were saying my story! And that was incredibly liberating. I felt seen for the first time.
Growing up, food was a huge part of how my family honored our culture. My parents celebrated food and believed in enjoying all foods. I never saw my mom restrict her diet or only eat salads. At the same time, there was so much mixed messaging. I was encouraged to participate to enjoy the food and family traditions that centered around food and at the same time I was constantly being told not to gain weight. There was this sense of showing loyalty to my culture don't abandon us but, in equal measure don't gain weight.
Thompson's book explained the damaging confusion of these mixed messages and why it was so upsetting to me. It also gave me more understanding of my parents, and particularly my mother who was an immigrant and had experienced oppression and the anxiety of assimilation in this country.
When my mom came to the US from Peru, she was learning English, looking for a job, and trying to assimilate. What she encountered as a brown woman with an accent, and all of the ways that our western culture regarded her, shaped in her the idea that in order to be successful and included she had to be thin. Even though roundness was celebrated in her culture, she saw that thinness was, and is, valued. Her thinking was: Of all the things that I am, if I'm thin, that can make up for it. It can be one less strike against me.
So, when I started to go through puberty, and gained puberty weight which is a natural, common, physical response to hormonal changes my mom began expressing her concern. I did not know how to make sense of these mixed messages around aspects of myself that were so personal, nuanced and vulnerable. I felt pressure and confusion around food and my changing body. Overwhelmed and angry, I began restricting my food to numb my pain and confusion. So that was how my eating disorder began.
Thompson's book sparked my life's calling my commitment to bring awareness and change to the huge gap that exists in treatment servicesfor underrepresented and underserved folks with eating disorders. Through this work, I have seen the vital role that diversity plays in the treatment of eating disorders. By bringing in different perspectives and expansive thinking to the field, we create greater possibilities for treatment and recovery for everyone.
Historically, the field of eating disorder recovery and treatment has taken a harmful and exclusive cookie cutter approach to address these issues. The myth that eating disorders only occur in affluent Caucasian girls is damaging to marginalized communities that suffer from eating disorders. This narrow viewpoint continues to reinforce an invisibility that is experienced by marginalized communities. It also limits our ability to understand the underlying problems that cause eating disorders and diminishes the deep complexities and layers that need to be revealed for true healing to occur.
If we think that there is only one perspective, and only one solution, we lock ourselves into one way of thinking for healing and recovery and that is limiting to everyone.
Healing and recovery is personal, individual, and complex. It means different things for different people. And each person's relationship with food is also complex. By bringing in diversity, both in thinking and experience, it allows us to find new, innovative ways to approach treatment. Where in our system and society do we need to change so that recovery is more possible for more people?
Eating problems are very pervasive. They are not confined to specific populations or groups of people. With this greater understanding, we can tap into different people's viewpoints and learn how they use treatment, which grows and strengthens our understanding of what treatment is. We can say, "Let's hear your stories. Let's hear what works for you. " We can hold healing and recovery as an evolving, expansive process. The more expansive we are the more we take on different angles of healing the more we will be able to think of inclusive and inventive ways to approach treatment and recovery. As we open and expand our approach and ideas around treatment, we create a whole new wave and energy that provides more hope and holds healing from eating disorders as absolutely possible.
Our world is diversifying and healthcare needs to respond
Our world is diversifying and will continue to do so. The growth of multicultural communities from sexual orientation, race, ethnicity, age, gender, etc., each with its own cultural traits and health profiles, present a complex challenge to health care providers and policy makers in providing equitable access. Access to healthcare, or mainly a lack of access, for marginalized populations, is one of the reasons for existing health disparities.These realities are present in our eating disorders field on many levels. It was hypothesized that eating disorders exist in solely in heterosexual Caucasian cisgender adolescent girls. However, more recent studies are showing that marginalized populations groups are reaching parity with heterosexual Caucasian cisgender adolescent girls in body image and eating disturbances suggesting that one's identity does not appear to protect against the broader sociocultural factors that foster body dissatisfaction and eating disturbances among adolescent females (Shaw,et.al., 2004; French, et.al. 1997.)Not only is treatment access an issue but eating disorders screening is another complication to be addressed (Becker,et.al., 2003). Multicultural eating disorders studies demonstrate that contributing eating disorder factors for multicultural populations may be unique to their race/ethnicity/sexual orientation/gender/age/disability,etc. (Harris and Kuba, 1997; Harris ,Kuba & O'Toole, 2012) . Often these contributing factors involve cultural dynamics, racism, and oppression, assimilation to dominant culture standards and identity confusion (Harris and Kuba, 1997; Harris ,Kuba & O'Toole, 2012).An even bigger question is are multicultural populations being diagnosed with eating disorders? Studies show that multicultural populations were significantly less likely than Caucasians to receive a recommendation or referral for further evaluation or care (Becker,A; et.al. (2003). Multicultural populations were also significantly less likely than Caucasians to have been asked by a doctor about eating disorder symptoms (Becker,A; et.al. 2003). These outcomes suggest a potential lack of reporting and diagnosis for multicultural populations that is a serious flaw in our health care system.The levels of impairment reported by marginalized populations with eating disorders coupled with their low levels of treatment utilization have serious consequences (Marques, et.al., 2010; Alegria,et.al. ,2007). These populations with eating disorders often remain undetected and this needs to be addressed. The levels of impairment reported by those with eating disorders coupled with the low levels of service use suggest serious consequences for marginalized populations suffering from these disorders, which can no longer be overlooked or remain undetected (Alegria,et.al. (2007).
- Alegria, M; Woo, M.; Zhun,C.; Torres, M.; Meng, X.; Striegel-Moore, R. (2007) "Prevalence and correlates of eating disorders in Latinos in the United States " International Journal of Eating Disorders; Special Issue: International Journal of Eating Disorders Special Supplement on Diagnosis and Classification, 40,S3, pg. S15 "“S21.
- Becker, A. et.al. (2003) Ethnicity and Differential Access to Care for Eating Disorder Symptoms " International Journal of Eating Disorders33, 205-212.
- 3French, S. et.al (1997) "Ethnic Differences in Psychosocial and Health Behavior Correlates of Dieting, Purging, and Binge Eating in a Population-Based sample of Adolescent Females " International Journal of Eating Disorders, 22, pg. 315-322.
- Harris, D. & Kuba, S. (1997) "Ethnocultural Identity and Eating Disorders in Women of Color " Professional Psychology: Research and Practice, 28(4), pg. 341-347. 5. Shaw,H, Ramirez,L., Trost,A., Randall,P., Stice,E. (2004) "Body Image and Eating Disturbances Across Ethnic Groups: More Similarities than Differences " Psychology of Addictive Behaviors, 18(1), pg. 12-18.