Treating black women with eating disorders

For Eating Disorders Awareness Week, Charlynn Small and Mazella Fuller, the co-editors of the groundbreaking new book, Treating Black Women with Eating Disorders, A Clinicians Guide, tell Orri about their reasons for coming together to write this trailblazing book.

This book is a first of its kind. Can you share more about why you felt prompted to come together and write this book?

Many healthcare providers fail to recognize eating disorders in Black women. Often practitioners take a colorblind approach to treatment, perhaps out of concern for being called racist or prejudice. However, to treat clients effectively, assessments must be thorough and culturally sensitive. If practitioners aren’t aware of correlations between Black women’s unique issues and the increased risk of eating disorders, then these potentially deadly disorders won’t be recognized in these groups, which decreases the chances of referral and treatment. Additionally, most eating disorder assessment measures were developed and validated in samples that did not include Black women. The result is that we don’t always meet criteria for eating disorders based on these measures when perhaps we should.

When it comes to evaluating Black women, what do you feel is unique about their experience with eating disorders?

For Black women in particular, eating problems evolved as ways to cope with traumas like racism. Often, Black women who are overweight are told — based on one-size-fits-all growth charts — to lose weight. We’re warned about heart disease and diabetes — issues we should consider. However, there usually isn’t any query about why we’re overweight. Black women are not monolithic. We have some unique issues and face challenges such as colorism, acculturative stress, and racism which are often directly related to our eating patterns. In addition, our children are disproportionately affected by adverse childhood experiences. For instance, Black children are more than twice as likely as White children to be sexually abused, and research shows an association between early childhood sexual abuse and eating disorders.

The book includes chapters with comprehensive case studies, examples of the treatment plan, together with discussions on both the clients’ physical health, as well as their lived experiences and impact on their emotional lives. Can you share more about how these two things come together?

In addition to racism and discrimination, we also cope with many of the same general issues as other groups – food deserts, single-motherhood, and co-occurring/maintaining factors like substance misuse, cutting and purging. Black women have myriad issues impinging upon us daily. For example, it is believed that acculturative stress and subtle racism is what predicts higher levels of bulimic symptoms among Black women. These are among the types of events that are often overlooked by some non-Black practitioners and clinicians. And if clinicians don’t know that these events are correlated with an increase in bulimic symptoms in Black women, then they aren’t processed and the clients don’t get well. All of these factors have the potential to impact the body image and identity of Black women. And identity really is at the heart of eating disorders. This is why these factors cannot be minimized or neglected during assessment and treatment.

What is your desire for the future direction when it comes to treating Black women with eating disorders?

The book offers a mixture of current research, best practices in treatment trends and clinical insight. Our hope is that the book will encourage increased cultural sensitivity training, further collaboration, research, and education on the unique issues concerning eating disorders in this underrepresented population. In this way, practitioners will be able to recognize the manifestations of their symptoms with greater frequency and accuracy.

Although this book is suggested for clinicians, in what way might Black women, who may be struggling with an eating disorder, or in recovery find this book helpful?  

The answer to this question is well summarized in part, in the book’s foreword by Becky Thompson. She wrote that “… a Black feminist ethic of care is rooted,” among other things, “… in creating practices so that they do not have to fight to live comfortably and with ease in their own bodies.” A number of young Black women have glanced through the book and exclaimed that it was about them. Responses from these women ranged from tearfulness to relief that their symptoms had been validated. Others were relieved to see documentation of the connection between events similar to some of their own lived experiences and their eating disorder symptomology. This knowledge provides hope for persons grappling with these disorders and for those in recovery.

Charlynn Small, PH.D, CEDS-S

Mazella Fuller Ph.D, MSW, LCSW, CEDS-s

Treating Black Women with Eating Disorders, A Clinicians Guide, provides in-depth, culturally sensitive material intended for addressing the unique concerns of Black women with eating disorders.

“Clinicians of any race will gain new tools for assessing, diagnosing, and treating disordered eating in Black women and will be empowered to provide better care for their clients.”

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