Examining Barriers to Eating Disorder Treatment in People of Color

BY: Rachel Uri

DATE: 10 October 2017

Historically, research examining eating disorders has focused largely on study samples of White/Caucasian women. Although the prevalence of eating disorder psychopathology is similar across races and ethnicities, there is a dearth of consideration to the precise mechanisms by which race/ethnicity may impact the etiology, presentation, and treatment of eating disorders in people of color. In particular, the current implementation of eating disorders therapy primarily evaluates traditional risk factors in non-White men and women, and fails to account for their unique experiences as people of color. Consequently, many people of color may encounter various barriers when seeking help for their eating disorders.

Deficiencies in the quality of eating disorders treatment for both men and women of color lie in both the application of treatment by clinicians and the treatment approaches themselves. The efficacy of current evidence-based treatment for eating disorders, such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), has been primarily assessed in White/Caucasian samples, with little attention paid to how these treatment options may affect a more diverse population. As treatment of eating disorders can be complex and highly individualized, it is critical to recognize that prevailing treatment methods may not be efficacious or appropriate for some people of color. Research examining eating disorders treatment for people of color is imperative to create empirically supported treatment approaches that are attentive to the racial and cultural background of the patient.

Furthermore, the ways in which clinicians undertake eating disorders treatment can also serve as barriers for people of color. Clinicians are less likely to recognize symptoms of disordered eating in women of color compared to White/Caucasian women, indicating the presence of racial stereotypes and assumption that may impede doctors’ ability to identify and treat eating disorders. Such biases can discourage individuals from seeking or continuing treatment. Additionally, cultural mistrust and other worries concerning being open with a therapist of a different racial/ethnic background may present themselves during treatment and could possibly hinder treatment outcomes if not discussed earnestly. Other reasons why people of color may not solicit treatment for their eating disorders may include, but are not limited to, a lack of insurance and/or financial resources, mistrust of the mental healthcare system, fear of shame or stigmatization, family privacy, and little awareness about available mental health services. Of particular significance is the “double” barrier that men of color may face when pursuing help for their eating disorder; while these individuals may be overlooked or disparaged as a result of their male status while suffering from a disorder traditionally acknowledged in females, they simultaneously face stigma as people of color. This dual obstacle to eating disorder identification, recognition, and therapy may seriously deter men of color from pursuing or even considering treatment for their eating disorder.

In order to improve the understanding of how eating disorders impact diverse populations, both researchers and clinicians should seek to better identify and comprehend the ways in which race/ethnicity may play a role in treatment. Increased attention to the development culturally appropriate treatment approaches should be pursued, particularly those centered around issues relevant to the patient. Treatment providers can discuss racial/ethnic stereotypes that may contribute to maladaptive eating patterns, negative self-schemas resulting from acculturation to unattainable beauty standards, or how racism and oppression influence self-perception. Additionally, clinicians should be aware of the unique sociocultural experiences of people of color, their worldviews, socialization, and cultural themes that may be relevant during treatment. For example, incorporating family-based treatment to extant CBT treatment for bulimia nervosa demonstrates a promising, culturally sensitive treatment adaptation that may be more accessible and effective for Latina women. It is crucial that the psychological community improves the existing therapeutic options for both men and women of color in order to provide treatment that offers the hope of recovery for every individual suffering from an eating disorder, no matter his or her background or experience.



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