Treating Black Women with Eating Disorders

A Clinician's Guide

Charlynn Small, Mazella Fuller, Charlynn Small, Mazella Fuller

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000091458
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

The first of its kind, this edited volume provides in-depth, culturally sensitive material intended for addressing the unique concerns of Black women with eating disorders in addition to comprehensive discussions and treatment guidelines for this population.

The contributing authors—all of whom are Black professionals providing direct care to Black women—offer a range of perspectives to help readers understand the whole experience of their Black female clients. This includes not only discussion of their clients' physical health but also of their emotional lives and the ways in which the stresses of racism, discrimination, trauma, and adverse childhood experiences can contribute to disordered eating. Through a wealth of diverse voices and stories, chapters boldly tackle issues such as stereotypes and acculturative stress.

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.

Part I
Perspectives and Politics

1
Eating Because We’re Hungry or Because Something’s Eating Us?

Charlynn Small

Introduction

As stated in the introduction to this book, though more attention is directed at underrepresented groups who grapple with eating disorders, for several reasons, many health care providers still fail to recognize these disturbances in Black women. One important reason for this failure is many practitioners fear asking the difficult questions¹ concerning racial differences and identity issues that can be instrumental in helping them recognize and understand potentially mediating factors in the development of eating disorders in Black women. Eating disorders are not recognized in this group often enough, largely because health care providers are not talking about them.

Undeniably, these topics can be quite difficult to broach. However, having the conversations or not having them can potentially impact Black women’s decisions to seek treatment or determine whether practitioners will properly diagnose Black women with eating disorders. In her autobiographical memoir, Hunger, Roxane Gay (2017, p. 201) wrote the following:

It’s hard for thin people to know how to talk to fat people about their bodies, whether their opinions are solicited or not. I get that, but it’s insulting to pretend I am not fat or to deny my body and its reality. It’s insulting to think I am somehow unaware of my physical appearance. And it’s insulting to assume that I am ashamed of myself for being fat, no matter how close to the truth that might be.

Similar to how Gay conveys that it is hard for thin people to talk to fat people about their bodies, it is often hard for White and some other non-Black therapists to talk to Black women about their lived experiences as Black women. Consider, for example, the juxtaposition of Gay’s quote and the following adaptation:

It’s hard for White people to know how to talk to Black people about their bodies, whether their opinions are solicited or not. I get that, but it’s insulting to pretend I am not Black or to deny my skin and its reality. It’s insulting to think I am somehow unaware of my physical appearance. And it’s insulting to assume that I am ashamed of myself for being Black, no matter how close to the truth that might be.

In the adaptation of Gay’s affirmation, certain words are different, but the connotations and the context are similar. Gay’s words were contextualized to accentuate the following dictum: To effectively treat Black women, health care providers must engage them in very difficult, often uncomfortable discussions about their bodies. As a Black woman and a licensed clinical psychologist who treats Black women with eating disorders, I am well aware that the hard questions must be asked of Black women, because often the answers are precursors to or are related to the development of their eating disorders. I must also note that the task of overcoming personal, racial, and systemic biases that act as barriers to effective work with Black women is not limited to White or non-Black professionals. Research suggests that Black clients can present unique challenges for Black practitioners (Goode-Cross & Grim, 2014; Goode-Cross, 2011). Similar physical appearances and other shared variables such as religious or social affiliations may facilitate or enhance the therapeutic alliance among same-race dyads (Goode-Cross & Grim, 2014). However, practitioners may differ from their clients in important ways (i.e., social class, country of origin, gender differences, political ideology, generational status, etc.) that could influence the dynamics of the therapeutic relationship in less favorable ways (Goode-Cross, 2011).

Colorism

Disordered eating and food rituals can result when emotional eating is habitually used to cope with macroaggressive and microaggressive events, colorism and its impact on Black women’s bodies, acculturative stress, and other traumas. Research suggests that issues of colorism are remnants of the institution of slavery and contribute to the intergenerational trauma that began with the systematic dehumanization of African slaves (DeGruy, 2017). White slave holders perpetuated skin tone stratification when they created a skin tone hierarchy among Black people that determined the tasks they completed and where they completed them. The system of race hierarchy that was created and the tasks associated with the particular levels or tiers of skin color carried a relative status and advantages that remain as powerful in sculpting our current existence as they did centuries ago (DiAngelo, 2018; DeGruy, 2017). Issues of colorism and related traumas are sources of intense debate and hurt feelings for many Black women. Yet their relevance to a client’s presenting concerns tends to frequently be overlooked by White therapists, and therefore are not processed. White therapists and other non-Black therapists who have limited exposure to persons from other races and cultures would not automatically be aware of the differences among Black women. Also, depending on some non-Black therapists’ educational histories or other demographics, it is even more unlikely that they would have knowledge of the significance of skin color, hair differences, and body issues among Black women.

Are Black women eating because we’re hungry or because something’s eating us? So much of our lived experience is about colorism: rejection and mis-treatment (Jackson-Lowman, 2013) and prejudice and discrimination against persons with dark skin by persons with fair skin—usually among people within the same racial or ethnic group (Hunter, 2007). Many Black people have the propensity to treat those with darker skin unjustly or less favorably than those with lighter skin. That is colorism at its core. This skin color stratification (Okazawa-Rey, Robinson, & Ward, 1987) is described as an expression of internalized racism (Association of Black Psychologists, 2013) and self-hate (Robinson, 2011). One example of how deep-rooted colorism operates is when Black people pose a question such as the following one: Is Vanessa Williams’s fair complexion prettier or somehow better than Lupita Nyong’o’s rich, dark-chocolate complexion? Many Black people firmly believe that the answer to this question is yes. While it is true that Vanessa Williams did win Miss America because she was indeed strikingly impressive, some Black people believe she won because she was strikingly impressive in a “White way,” for she possesses fair skin, blondish hair, light-colored eyes, and at that time (1983), a petite frame.

Thus, in addition to societal racism and bigotry, for many of us, our lived experiences often include daily messages from our own groups that influence their members to deduce: “There’s something wrong with me.” These messages that are typically experienced from a very early age impact developing self-concepts and identity. Evidence of the negative impact of these messages on Black children’s self-esteem and identity were demonstrated in the seminal Doll Test studies conducted by Kenneth and Mamie Clark during the 1940s. The Clarks found that as the result of “prejudice, discrimination, and segregation,” these children experienced feelings of inferiority and a damaged sense of self-esteem (Clark & Clark, 1947). Low self-esteem has long been determined to be one of many significant underlying triggers involved in the development of disordered eating patterns.

Hair

Black women’s hair has forever been controversial. It’s been studied and examined from almost every conceivable perspective and within many different contexts, e.g., socially, culturally, and politically (Ashe, 2015). Hair texture and style have always elicited strong feelings and dialogue in Black communities. From the slave owners’ derogatory insults of “burrhead” to Madam CJ Walker’s improvement of the hot comb in the early 1900s to straighten our naturally curly tresses to the soulful pride and sophistication with which we donned our Afros, Black hair has always been an enormous deal. There have been as many statements made about Black hair as there have been statements made by Black hair. Black people of all ages have been barred, banned, prevented, or dismissed from public places, employment, and school because of the politics surrounding their hair. In a horrifying, mean-spirited act of what many have decried as racism and an abuse of power, New Jersey high school wrestler Andrew Johnson was forced to have his dreadlocks cut off during a match (NBC, 2019). There have been numerous occurrences of Black children being suspended from school or otherwise penalized because their natural hairstyles violated dress codes, as was the case with 12-year-old Florida student Vanessa VanDyke, whose “puffy” hair was deemed a distraction (Kim, 2013). Similarly, 16-year-old twins Mya and Deanna Cook were charged with violating their Boston area school’s dress code because of their braided extensions (Lattimore, 2017), as was 11-year-old Faith Fennidy by her Terrytown, Louisiana school (Jacobs & Levin, 2018). These styles have often been called aggressive and unacceptable.² Such actions in the US school system perpetuate racial discrimination, education disparities, and trauma in Black communities. These types of experiences can adversely impact children’s self-esteem and identity development, leaving them again to assume that “There’s something wrong with me.” These kinds of acculturative stressors have been linked to an increase in the prevalence of eating disorders in Black adolescents.

Black women’s hair has always been a politicized issue that leaves them asking complex questions about their hair: Should we wear our hair naturally curly—the way it grew out of our heads and then coiffed into Afrocentric styles like Afros, braids, twists, and locks? Should it be worn chemically or heat-treated, or with bone-straight, fake hair weaved in, often at the risk of being accused by other Black persons of trying to be, look, or act White? As Black women continue to wrestle daily with identity and pressures to assimilate (Taylor et al., 2013), these issues become significant factors in the development of disordered eating.

Body

Another issue that generates strong emotion among Black women concerns the size and shape of their bodies and body parts, leaving them musing on other aspects of themselves. Do an ample bosom and voluptuous hips make some Black women more desirable than some less well-endowed Black women? Or vice versa? Sociocultural models of eating pathology predict lower risks for disorders in Black women because of their cultures’ alleged embrace of voluptuous, more attainable body types, theoretically empowering Black women to resist the need to adopt or strive toward the goal of thinness (Gordon, Castro, Sitnikov, & Holm-Denoma, 2010). However, when fuller-figured, voluptuous Black women exist in environments outside of their Black communities, i.e., on predominantly White college campuses, they often find they are not cherished or desired. In other words, they often learn that a full figure is not the admired standard of beauty. Therefore, these women’s risk of developing eating disorders increases as the result of trying to navigate spaces in which they feel devalued (Kempa & Thomas, 2000).

Acculturative Stress

Thompson (1994) found that eating problems evolved as survival strategies and ways women could cope with traumas such as racism. Aside from tensions arising from the myriad differences existing among Black women relating to body image, they face a range of innumerable difficulties affecting them in other ways as well. They continually experience anxiety from the invalidating, intimidating microaggressions (daily verbal or behavioral racial slights or indignities that can be intentional or unintentional; Sue, 2010) of acculturative stress. These assaults often come in the form of complementing our articulation and mastery of the dialect called standard American English, though those skills are not anomalous for Black people. These assaults also come in the form of White fright—when a White woman clutches her purse on an elevator after a Black person enters (Sue, 2010). The subtlety of some of these psychosocial stressors can be difficult to ascertain because of their ambiguity. The uncertainty of whether you have been the recipient of an act of subtle racism can be particularly distressing. Persistent exposure (Kempa & Thomas, 2000; Carter & Muchow, 2017) to these kinds of stressors or even one such surprising encounter can be intensely traumatizing, resulting in recurrent intrusive thoughts, anger, anxiety, depression (Carter & Muchow, 2017), and disordered eating (Taylor et al., 2013). A growing body of literature shows that these types of events can yield profoundly negative effects on the health of victims who are predominately Black. For example, Merritt, Bennett, Williams, Edwards, and Sollers (2006) found significant elevations in blood pressure and heart rate in response to subtle expressions of racial discrimination in a sample of Black men.

Black populations also struggle with the pressures and effects of macroaggressions (participation in or compliance with big systems of oppression) such as redlining and housing discrimination (Rothstein, 2017), school-to-prison pipelines (Seroczynski & Jobst, 2016), restriction of employment opportunities (Quillian, Pager, Hexel, & Midtboen, 2017), and police misconduct and human rights violations (Davis, 2017). Eating disorders can result from patterns of emotional eating to cope with these types of events.

Abuse, Neglect, and Other Trauma Exposure

A large body of research links disordered eating with a history of trauma exposure (Briere & Scott, 2007). This research shows that persons who have experienced abuse, neglect, or other traumas for long periods are particularly vulnerable to the damaging influences of eating disorders (Briere & Scott, 2007). Similarly, evidence shows that persons who report disordered eating symptomology have likely been victimized in some way as children, as adolescents, or as adults (Briere & Scott, 2007). Yet Black women grapple with the traumatizing effects of physical, sexual, and emotional abuse and neglect at alarmingly high rates compared with others. This may be related to findings from a number of studies on health outcomes, disease prevention, and intervention showing that Black children are disproportionately affected by adverse childhood experiences (i.e., sexual, physical, or emotional abuse, household dysfunction, neglect, etc.) more often than White and other non-Black children (Maguire-Jack, Font, & Dillard, 2019; ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Acknowledgments
• Foreword
• Introduction
• PART I Perspectives and Politics
• PART II Medical Management
• PART III Nutrition and Weight Concerns
• PART IV Treatment Approaches and Philosophies
• PART V Addressing Special Populations
• About the Editors
• List of Contributors
• Index