Disordered Eating in Women of Color: Some Counseling Considerations

There is little attention devoted to studying eating disorder symptoms in racially and ethnically diverse groups despite the fact that the prevalence rates among women of color for eating disorder symptoms are similar to those of European American women. This article reviews research related to eating disorders in women of color, including a discussion of sociocultural factors that could influence the manifestation of eating disorders in women of color. Considerations for counseling practice and research are provided.     

Early puberty in African-American girls: nutrition past and present

This study focused on nutrition and the changes in food intake over time to explain the onset of early pubertal signs in African-American girls. The daily nutritional intake of two diametrically opposite generations of African-American females was compared. The first group included 20 girls between the ages of 5 and 7 and the second group included 28 women between the ages of 70 and 85. The older African-American women were asked to remember the meals they had when they were young. Results revealed significant differences in terms of both quantity and quality of food consumed. Specifically, the women reported eating two meals a day when they were young while the girls reported eating at least three meals. Also, for breakfast, the girls consumed significantly more milk and fruits than did the women. For lunch, the girls consumed significantly more bread and grains, vegetables, meat, and milk than did the women. For dinner, the women consumed significantly more bread and grains. Thus, significant differences between the nutrition of African-American girls about 60 to 70 years ago and those of today were revealed. Implications of these findings are discussed.     

Perceptions and metaperceptions of same-sex social interactions in college women with disordered eating patterns

This study compared perceptions and metaperceptions after a social interaction between a woman with disordered eating (subclinical bulimia nervosa) and a female interaction partner. Hypotheses were: women with disordered eating would have more negative metaperceptions of social interactions than women without disordered eating, and women with disordered eating would show a greater discrepancy between metaperceptions and perceptions than women without disordered eating. All participants completed questionnaires about their perceptions and metaperceptions post-interaction. Results showed women with disordered eating thought that they had made a negative impression; findings addressing the relationships among social desirability, loneliness, social support utilization, and fear of negative evaluation are also discussed.     

An evaluation of the reliability and construct validity of eating disorder measures in White and Black women

Most measures of eating disorder symptoms and risk factors were developed in predominantly White female samples. Yet eating disorders affect individuals of all racial and ethnic backgrounds. Black women appear more vulnerable to certain forms of eating pathology, such as binge eating, and less susceptible to other eating disorder symptoms and risk factors, such as body dissatisfaction, compared with their White peers. Despite concern that extant measures do not adequately assess eating concerns among Black women, the construct validity of scores on most of these measures has not been adequately examined within this population. This study included 2,208 Black and White women who completed the following: the Binge Eating Scale (BES), the Eating Disorder Diagnostic Scale (EDDS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorder Inventory Body Dissatisfaction and Drive for Thinness subscales, the Bulimia Test-Revised (BULIT-R), the Multidimensional Body-Self Relations Questionnaire-Appearance Evaluation subscale (MBSRQ-AE), and the Objectified Body Consciousness Scale (OBCS). Most measures yielded internally consistent scores in both races. Confirmatory factor analyses indicated that loadings for some measures, including the EAT-26 and EDDS, were not invariant across groups and thus do not assess equivalent constructs in White and Black women. However, others, including the BULIT-R, BES, OBCS, and MBSRQ-AE, exhibited factorial invariance in both races. Results suggest scores are likely not equivalent across races for several popular measures of eating disorder symptoms and risk factors. Thus, it is recommended that researchers and clinicians obtain additional information regarding racial/cultural factors when using these instruments with Black women.     

Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

This study evaluated the effectiveness of dialectical behavior therapy (DBT) for treating eating disorder episodes and co‐occurring depression symptoms among individuals diagnosed with eating disorders. Separate meta‐analytic procedures for between‐groups and single‐group studies were conducted and yielded large effect sizes, indicating that DBT may be efficacious for decreasing disordered episodes among women diagnosed with eating disorders; medium to large effect sizes were noted for treating depression symptoms. Implications for evidence‐supported practice and study limitations are discussed.     

Mother Mary Ann Wright

The role of African-American women in community service and social activism is well known. In this paper, the researcher provides a case study of a present-day African-American social activist and makes comparisons with the community service experiences of other African-American women in the past. Mother Mary Ann Wright describes herself as a servant of God. As with other African-American women, it is God who provides her identity and sense of purpose. Likewise, because she serves God, she has status in her community. Mother Wright is an exceptional woman-born in abject poverty, having pulled herself up by her bootstraps-all the while listening to the voice of God, she has founded missions throughout the world and is best known for her work in feeding the hungry in the parks of Oakland, California. She gives all credit for her accomplishments to God. However unique and outstanding, Mother Wright also epitomizes a long tradition of African-American women whose spirituality directed their service to their fellow human beings. The list is long and the variety of these women is great-the well educated leaders as well as the ordinary-Pauli Murray, Mary McLeod Bethune, Sojourner Truth, Harriet Tubman, and thousands of other African-American women have dedicated their lives to uplifting the race and improving the human condition. The story of Mother Wright, a special and exceptional women in her own right, nevertheless confirms the continuation of the tradition of spirituality and public service among African-American women.     

Eating patterns and disorders in a college population: Are college women's eating problems a new phenomenon?

This paper examines the relationship between gender differences in eating patterns among college students and the disorders as clinically defined. A considerable number of college women but few men in our sample show behavioral patterns associated with an eating disorder (anorexia or bulimia). Our findings for women are in the moderate to high range for these symptoms, compared with other university populations. Results indicate that the eating difficulties of college women may be an eating problem, which only partially resembles clinical eating disorders. Although our female college sample displays the behavioral symptoms associated with anorexia and bulimia, they exhibit few of the constellation of psychological traits associated with these disorders. Some evidence suggests that the etiology of eating problems may be partly related to women wanting to be thinner than is medically desirable and may represent a response of normal women to the new, more demanding cultural and supercultural standards for thinness. Diagnosis and treatment issues as well as sociocultural implications of these results are discussed.The author wishes to thank Alan Clayton-Matthews, Larry Zaborski, John Downey, Larry Ludlow, the Editor, and an anonymous reviewer for their helpful comments. This research was supported, in part, from a grant from the Office of Research Administration, Boston College.     

Body image: gender, ethnic, and age differences

Using figure drawings (E. Fallon & P. Rozin, 1985), 120 male and female U.S. college students--African American, Hispanic, and Caucasian--indicated their current and ideal figures, the figures that they considered most attractive to the opposite sex, and the opposite-sex figures most attractive to themselves. Dissatisfaction with body shape was greater among the women regardless of ethnicity. Both the men and the women misjudged which shapes the opposite sex would rate as most attractive: The women guessed that the men preferred shapes thinner than those that they actually reported. The African American women had the most accurate perceptions of what the men found attractive, whereas the Caucasian women had the most distorted views. The men guessed that the women preferred shapes bulkier than those that they actually indicated. These findings may be relevant to the lower incidence of eating disorders among African American women and the higher incidence of such disorders among Caucasian women.     

DISORDERED EATING, ACCULTURATION, AND TREATMENT-SEEKING IN A COMMUNITY SAMPLE OF HISPANIC, ASIAN, BLACK, AND WHITE WOMEN

The purpose of this study was to examine disordered eating, acculturation, and treatment-seeking in a community sample of Hispanic, Asian, Black, and White women. Participants were 118 women with disordered eating (49 Hispanic, 21 Asian, 23 Black, and 25 White) and 118 healthy controls. Interviews were conducted to assess eating and weight-related behaviors, psychiatric symptoms, acculturation, and health care usage. Results indicated that the four ethnic groups were equally likely to present behavioral symptoms of bulimia, anorexia, or a binge-eating disorder. Hispanics were the most likely to use diuretics, and Black women were the most likely to use laxatives. Despite psychological distress among the eating disorder group, only a small percentage had received treatment during the past year; the eating disorder group was more likely than the controls to report that they had been denied treatment. More acculturated individuals were more likely to suffer from eating problems, and among the eating disorder group, less acculturated individuals were less likely to have received treatment.     

College women: eating behaviors and help-seeking preferences

Late adolescent women at a large, mid-Atlantic university were surveyed. Of the 578 who completed the survey, 17% were found to have eating disorders as defined by a score of 20 or above on the Eating Attitudes Test (EAT-26; Garner, Olmstead, Bohr, & Garfinkel, 1982). Participants who scored 20 or above were younger and more likely to be white, in a sorority, and Christian than were those who scored below 20 on the EAT-26. No correlation was found between EAT-26 scores and participation in organized athletics. In addition, the participants were asked about their choice of help and support should they have any worries about their eating. They were most likely to say that they would prefer a close friend to support them when dealing with disordered eating, followed by their parents and their significant other. In terms of professional services, most women reported that they would prefer individual assistance such as a consultation with a physician, a nutritionist, or a therapist, followed by family therapy, if they ever had questions about eating or thought they needed professional help with disordered eating.     

Body Image: Gender,Ethnic, and Age Differences

Abstract

Using figure drawings (E. Fallon & P. Rozin, 1985), 120 male and female U.S. college students–African American, Hispanic, and Caucasian–indicated their current and ideal figures, the figures that they considered most attractive to the opposite sex, and the opposite-sex figures most attractive to themselves. Dissatisfaction with body shape was greater among the women regardless of ethnicity. Both the men and the women misjudged which shapes the opposite sex would rate as most attractive: The women guessed that the men preferred shapes thinner than those that they actually reported. The African American women had the most accurate perceptions of what the men found attractive, whereas the Caucasian women had the most distorted views. The men guessed that the women preferred shapes bulkier than those that they actually indicated. These findings may be relevant to the lower incidence of eating disorders among African American women and the higher incidence of such disorders among Caucasian women.     

The bad taste of social ostracism: The effects of exclusion on the eating behaviors of African-American women

African-American women experience disproportionately higher rates of obesity than do Caucasian women. The stress African-American women encounter from experiences of discrimination may influence their eating behaviours, which could contribute to weight gain. Emotional eating theory suggests some people increase their intake of high-calorie foods to cope with stressful experiences. We investigated the effects of social exclusion by other African-American women or by Caucasian women for African-American women’s distress and food consumption using a laboratory paradigm. As hypothesised, there were main effects of ostracism and interactions between ostracism and race, although not all of the interactions took the expected form. As hypothesised, African-American women ate more potato crisps after being excluded by Caucasians than by African-Americans. Unexpectedly, African-American women who were excluded by other African-American women self-reported more emotional distress than did African-American women excluded by Caucasian women. These findings suggest that ostracism by both in-group and out-group members are disturbing, although people may respond to in-group and out-group exclusion in different ways. Directions for future research are suggested that could elucidate the circumstances under which different emotional and behavioural coping responses are employed.     

Bulimic Eating Disorders in Primary Care: Hidden Morbidity Still?

The current study examined the features of women with bulimic-type eating disorders (n = 24) attending primary care in two smaller urban regions of the USA. The assessment included measures of eating disorder psychopathology, medical comorbidity, impairment in role functioning, potential barriers to treatment and actual use of health services. Eating disorders, primarily variants of bulimia nervosa and binge eating disorder not meeting formal diagnostic criteria, were associated with marked impairment in psychosocial functioning. Although two-thirds of participants recognized a problem with their eating, less than 40% had ever sought treatment from a health professional for an eating or weight problem and only one in ten had sought such treatment from a mental health specialist. Only one-third had ever been asked about problems with eating by a primary care practitioner or other health professional. However, more than 80% had sought treatment from a health professional for symptoms of anxiety or depression. Most reported some degree of discomfort in discussing eating problems with others, and half reported that they would not be truthful about such problems if asked. Having an eating disorder was associated with several chronic medical conditions, including joint pain, gastrointestinal problems and fatigue. Although the small sample size limits any firm conclusions, the findings suggest that the health burden of bulimic-type eating disorders is substantial but remains largely hidden. Efforts may be needed to improve the eating disorders “mental health literacy” of both patients and primary care practitioners in order to facilitate early, appropriate intervention.     

Gender role typing,the superwoman ideal,and the potential for eating disorders

The interactive effects of gender role typing and adherence to a superwoman ideal (desiring to excel in many diverse roles) on the potential for disordered eating were examined among a nonclinical sample of women. Results indicated that both masculine and feminine gender-typed women who strongly adhered to a superwoman ideal were at greater risk for eating disorders than androgynous superwomen. In contrast, androgynous superwomen had relatively low potential for disordered eating and appeared comparable to women who, regardless of gender typing, rejected the superwoman ideal. Women undifferentiated with regard to gender type, whether superwomen or not, also had reduced potential for disordered eating. Findings are discussed with regard to gender role socialization and expectations, and the implications for mediating the potential for eating disorders are considered.     

The Buffering Role of Social Support Perceptions in Relation to Eating Disturbances among Women in Abusive Dating Relationships

Abuse is often associated with diminished social support networks, which typically serve to buffer individuals against stress-related outcomes, including eating disorders. The goal of the present study was to examine whether eating disturbances among women in abusive dating relationships varied as function of perceived social support. Although both physical and psychological aggression in women's (N=83) dating relationships was associated with symptomatic dieting and bulimic symptoms, only psychological aggression predicted unique variance. Although psychological aggression was directly related to eating symptoms, support from friends diminished the relation to bulimic symptoms, possibly because such support facilitated women's ability to distract themselves from their abusive situations. In contrast, perceived parental support buffered women in physically abusive relationships from disturbed eating patterns. Thus, depending on the nature of abuse women experienced, social support resources were differentially effective in buffering women from eating disturbances.     

An Overview of Trauma-Informed Care and Practice for Eating Disorders

ABSTRACT

This article reviews concepts and principles of trauma-informed care and trauma-informed practice for those with eating disorders (EDs). EDs are not universally recognized to be associated with traumatic events, despite substantial research evidence indicating that individuals with EDs report very high rates of childhood maltreatment, other lifetime traumatic events, as well as adverse consequences from trauma. Using national representative samples, higher prevalence rates of PTSD and other trauma-related comorbidities have been reported in those with EDs, particularly those with bulimic symptoms (binge eating and/or purging). Evidence suggests that those prone to develop EDs appear to be especially sensitive to the effects of stress/adversity and have high rates of premorbid anxiety disorders, personality traits, and neuropsychological features that predispose them to PTSD and its symptoms. This article also reviews some of the important principles for treating individuals with EDs comorbid for PTSD and other trauma-related disorders, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols. Integration of existing evidence-based treatments, including family therapy, cognitive behavioral therapy, dialectical behavior therapy, cognitive processing therapy, prolonged exposure, and eye movement desensitization reprocessing are recommended. Recent research suggests that ED clinicians view integrated treatment for individuals with ED and PTSD as a top priority, yet they have several concerns about administering such a treatment. As trauma-informed care is embraced by all clinicians and treatment programs that assess and treat eating and related disorders, better outcomes are anticipated.     

Three boys and their stories: Atypical eating and primitive relations1

Eating disorders of whatever category, especially the most severe ones such as anorexia or bulimia, are often considered typical of the female sex. While this is correct concerning these two disorders, I suggest that there are other eating disorders that are more frequent among boys, especially the ones concerning atypical relations to food, notwithstanding the evidence that the already very well‐known syndromes of bulimia and anorexia are also gaining ground among males. However, similar, unspecified eating disorders do not seem to occur so often among girls. Clinical data from my private practice should be taken for granted considering these matters, since I do not yet have statistical data to back up my thesis. In examples from three clinical cases involving boys and one female vignette, I shall attempt to establish a relation between eating disorders and primitive relations with men and women. This relation goes well beyond the oft‐cited ‘contemporary’ causes of eating disorders. In addition, I shall situate these differences among symptoms of both sexes and relate them to impasses in different stages of emotional development, as well as to the extent to which girls’ identification with their mother’s sex can influence their acquisition of eating disorders.     

Role of attention, memory, and covariation-detection processes in clinically significant eating-disorder symptoms

Cognitive theorists implicate a role for cognitive processing of shape- and weight-related information in the maintenance and potential etiology of eating disorders. The present study examines the role of women’s processing of information regarding other women’s body size and affect in eating disorder symptoms among young women. 253 female undergraduates completed attention, memory, and covariation-detection tasks that presented full-body photographs of young women, as well as an eating-disorder measure. High-Symptom women, relative to Medium- and Low-Symptom women, showed greater relative attention to body size than affect, better memory for body size and worse memory for affect, and enhanced sensitivity to the manipulated covariation between body size and affect. All participants perceived an illusory correlation between body size and affect. These findings suggest that cognitive theories may be extended usefully by considering processing of other-relevant and affective information, as well as the role of covariation-detection processes in eating disorders.     

School counselors' knowledge of eating disorders

The purpose of this study was to examine school counselors' knowledge of adolescent eating disorders, specifically anorexia and bulimia nervosa. Participants were drawn from the national membership of the American Association of School Counselors; they were requested to complete a 43-item questionnaire on eating disorders. Of the 500 participants randomly selected, 337 (67%) returned usable questionnaires. There were 220 female and 117 male counselors; the mean age was 45.2 years. The majority held a master's degree and counseled high school students; the mean number of years they had been school counselors was 12.2. When asked how competent they were in helping students with eating disorders, 11% rated themselves as very competent, 49% believed they were moderately competent, and 40% believed they were not very competent. The majority (75%) did not believe it was their role to treat students with eating disorders; they were instead referred to an eating disorders program (40%), their parents (34%), or a psychiatrist or other physician (34%). The majority of counselors (72%) had encountered anorexic or bulimic students; the most common method of discovering students with a problem was by being informed by fellow students (35%). The majority of respondents were very knowledgeable regarding the signs and symptoms of anorexia and bulimia nervosa. Examination of their general knowledge of eating disorders revealed that they knew more about anorexia than bulimia. The two sources of eating disorders information utilized by at least half of the respondents were professional journals (70%) and workshops/professional conferences (56%).     

An Examination of the Connections Between Eating Disorder Symptoms,Perceived Burdensomeness,Thwarted Belongingness,and Suicide Risk Among Undergraduate Students

Suicide attempts and premature mortality due to suicide are elevated in people with eating disorders. Informed by the interpersonal theory of suicide, two studies examined the role of perceived burdensomeness and thwarted belongingness in explaining the association between eating disorder symptoms and suicide risk. Results indicated that various eating disorder symptoms had an indirect effect on suicide risk through perceived burdensomeness and thwarted belongingness. Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.