OPINION
02/26/2018 02:35 pm ET Updated Feb 26, 2018

Anorexia And Bulimia Are Black Women's Diseases, Too

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In 2007, I joined an online community called ANA ― a cute and cuddly name for people with anorexia nervosa, the world’s deadliest mental illness. I found them the same way I had found Xanga and Napster before that: by spending uninterrupted hours on the internet between “Laguna Beach” marathons. A few months later, I had dropped 30 pounds from a combination of starving, diet pills, diuretics and silent regurgitation punctuated by guilt-laden binges. The compliments and high-fives and constant exclamations of “You look great!” made me keep my disordered eating to myself. It was actually easy, thanks to a widely held belief that black women don’t have eating disorders. But that’s verifiably not true. 

Just a year before the peak of my EDNOS (eating disorder not otherwise specified) behavior, a study found that clinicians were less likely to assign an eating disorder diagnosis to a fictional character based on her case history if her race was African-American rather than Caucasian or Hispanic. The study affirmed what many of us already knew ― that eating disorders are seen as something that happens to white women.

White women are certainly the most visible victims of eating disorders. In fact, many of the women I borrowed tips and tricks from were white: my cheerleading buddies who tried to stay as close to 100 pounds as possible; the girls online who had similar stresses, but not curves or body types like mine; the girls in movies hiding their food and skipping meals. The National Eating Disorders Association reports that accounts of eating disorders among ethnic minorities are growing, but statistics on the prevalence of eating disorders among women of color still aren’t available. The NEDA believes this is most likely due to the longstanding but erroneous idea that eating disorders only affect white women ― a misperception that may lead to research and reporting biases, and result in relatively little research involving participants from racial and ethnic minority groups.

I didn’t know how to deal with stress, but I did know how to deal with my appearance.

In 2009, a group of economists at the University of Southern California debunked the eating disorder myth of the “rich white girl.” They found that “girls who are African American are 50 percent more likely than girls who are white to be bulimic,” according to a press release, “and girls from families in the lowest income bracket studied are 153 percent more likely to be bulimic than girls from the highest income bracket.”

Communities of color often experience high rates of anxiety, and overeating or refusing to eat are common responses to stress. However, because the black community avoids talking about these disorders, our suffering remains under the radar. “Frequently, someone may be facing some kind of distress and not know how to manage it,” says Dr. Lesley Williams, a board-certified eating disorder specialist. “Instead of talking to someone about it, they look to food as a form of comfort.” Williams notes that for her patients, “many times, turning to food is more acceptable than [seeking] professional help, therapy or even medication.”

I didn’t know how to deal with stress, but I did know how to deal with my appearance. In my family, like most families, making jokes about people’s appearances is as natural as breathing ― an inhaling and exhaling my thighs couldn’t escape. Add that to the envy I had for the slim physiques of the girls in my mostly white cheerleading squad and the stress I had with keeping up appearances, and it became a perfect storm for an eating disorder to emerge. And no one, not even my doctors, saw anything wrong.

This lack of awareness in professionals who treat and research eating disorders is not only disturbing ― it’s dangerous. Stephanie Covington Armstrong, author of Not All Black Girls Know How to Eat, spoke to Slate about this in 2014. In an attempt at recovery, Armstrong decided to take part in a study on bulimia. But when she got to the researcher’s office, the doctors looked confused, telling her she was the first African-American applicant in the program. “It really just pissed me off,” she said. “I felt like the purple giraffe in the room ― people aren’t used to women of color coming forward with problems or issues.”

In 2017, a study conducted on college campuses found clear discriminatory practices among health professionals when acknowledging, diagnosing and treating eating disorders in young black women versus their white counterparts. Evidently influenced by the stereotype of the “strong black woman,” doctors in the study appeared not to believe that black women are susceptible to disordered eating. One of the professionals interviewed for the study, who worked in counseling and psychological services at a largely white Southern school, said she wasn’t aware of recent research on disordered eating in non-white women. This person, who specialized in eating disorders, said she’d heard “talk in the past that non-white women had different perspectives on what was acceptable in terms of body shape and size,” but she didn’t know if “that theory has already been debunked.”

Hurdles like these, together with the distrust of medical professionals that many people of color feel, can discourage black people with eating disorders from seeking help.

We have to check our assumptions when it comes to the way we talk about eating disorders in black women.

Doctors in my own life failed to notice the signs of my anorexia. In high school, after living off coffee and water for too long, I was hospitalized for dehydration and a kidney infection. My doctor commented on how much my weight had dropped since my previous visit, but never associated it with why I was in the hospital. I was able to go home once I was released, quietly carrying on with my disorder. In college, I used my attention deficit hyperactivity disorder to my advantage, getting prescribed Adderall and using it to aid my fasting. The doctor who conducted my physicals before writing my prescription noticed I’d lost 15 pounds since my previous visit. I told him my weight loss had been intentional, and just like that, he never brought it up again.

In high school, when my weight dropped so low that I started to look gaunt and unhealthy, my parents gave me an ultimatum: If I didn’t stop what I was doing, I wouldn’t get to leave for college in the fall. I started eating just enough to not get in trouble, but there was never talk of treatment except as a punishment. There may be multiple reasons my parents dealt with my issue the way they did. In the African-American community, the real priority is often survival: making money to take care of your children and somehow achieve success in a racist society. This causes some people to regard certain problems as just not real or significant enough. But mental illness in the black community can’t be mediated if issues like eating disorders aren’t seen for the danger they are.

Now, some 10 years later, I’m still learning how to eat ― but the truth is, I’ll probably never really know how. But my desire to take care of myself has finally outgrown my need to control stress by hurting my body. I no longer lean into the stigma or tell myself I can’t seek help. In fact, I’ve learned to speak up and ask for help when I need it. Eating disorders don’t discriminate when it comes to race, which is why we have to check our assumptions when it comes to the way we talk about, treat, and view eating disorders in African-American men and women.

Erica Hawkins is a Baptist preacher’s daughter and Atlanta-based music writer with too much spirit for her circumstance. Read her stories on bands, life, and culture at ericahawkins.com.

If you’re struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.

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