What kind of person do you imagine when you hear the term eating disorder? For many people, a specific type of person comes to mind: a young, rich, White woman who’s suffering from anorexia nervosa, perhaps because she is striving to attain the hyper-thin body ideal promoted in many types of media images.
This stereotype can blind us to two important pieces of data. First, there are multiple types of eating disorders and a broad set of symptoms associated with them. Not all of those with eating disorders engage in heavily restricted eating. Second, eating disorders affect all ethnicities. Recent research led by the Veterans Affairs Portland Health Care System found that eating disorders affect ethnic minority women just as much as they affect White women. On top of that, the factors that increased the risk of developing an eating disorder were highly similar across all ethnic groups studied.
Though most people think of anorexia or bulimia when they hear the term eating disorder, in 2013, the American Psychiatric Association’s new edition of the Diagnostic and Statistical Manual of Mental Disorders made a third major type of eating disorder diagnosis “official.” It’s called Binge Eating Disorder, and it involves recurrent episodes of binge eating that cause significant distress or impairment.
The term binge eating doesn’t refer to just over-eating. Instead, it’s marked by characteristics like eating much more rapidly than normal, eating until you’re uncomfortably full, eating a lot even when you’re not hungry, and eating alone out of shame about the amount you’re eating. Unlike bulimia, where people binge eat and then engage in often dangerous compensatory behaviors like vomiting or laxative abuse, people with binge eating disorder don’t “purge.” Many earlier studies on ethnicity and eating disorders failed to include binge eating disorder; the psychologists behind this new study examined all three eating disorders.
The study included over one-thousand high school girls and college women (5 percent were African American, 11 percent Asian American/Pacific Islander, 12 percent Hispanic American, and 72 percent White Americans). All of the girls/women in the study were interviewed or surveyed multiple times—at one month, six months, one year, two years, and three years. At each point, they were screened for behaviors like fasting, overeating, and excessive exercise. Anyone who met the criteria for an eating disorder at the first time point of the study was excluded from the analyses. This allowed the researchers to examine who developed an eating disorder over the course of the study.
The researchers found that eating disorder rates were quite similar across the ethnic groups studied. Around 20 percent of White, Hispanic American, African American, and Asian American participants showed evidence either of an eating disorder or a subthreshold eating disorder. (The term “subthreshold eating disorder” refers to cases in which someone has eating disorder symptoms that are causing significant impairment, but that do not meet the most stringent criteria for diagnosis of a disorder.) All four groups also showed similar levels of a number of variables that reliably predict the onset of eating disorder symptoms, including body dissatisfaction, negative mood, overeating, fasting, and excessive exercise.
The authors concluded that when it comes to eating disorders and risk factors for eating disorders, girls and women who are members of different ethnic groups have more similarities than differences.
Stereotypes about eating disorders matter. Those who are members of groups viewed as less likely to have an eating disorder (including men — although men weren’t included in this research) may be less willing to seek treatment. These stereotypes can also make health care practitioners less likely to recognize important eating disorder symptoms in their patients.
Careful screening for eating disorders is essential, as all three major types of eating disorders are associated with significant negative health outcomes. For example, anorexia and bulimia are linked to an increased risk of suicidality, as well as endocrine problems, osteoporosis, and gastrointestinal diseases. Binge eating disorder is associated with a wide range of health problems (e.g., sleep disorders, cardiovascular disease, and diabetes) that can’t be explained by weight gain alone. The more we challenge our preconceived ideas about who is vulnerable to eating disorder symptoms, the better able we will be to get help to those who need it.