The stereotypical image of a person with an eating disorder is a young, white woman. This image is the one we’re presented with in most media discussions of eating disorders. The truth is that anyone from any background can develop an eating disorder. People who don’t fit the stereotypical image, like Asian-Americans and Pacific Islanders (API), may face barriers to treatment. Clinicians may not recognize their ED symptoms. Cultural expectations may also make it difficult to get treatment. Let’s take a closer look at eating disorders and the API community.
Are There Eating Disorders in the API Community?
Medical research has often focused on non-Latino white participants. This includes eating disorder research. In the past 10 years, researchers have worked to better understand eating disorders in other ethnic groups. One study that appeared in the International Journal of Eating Disorders in 2011 looked at eating disorder prevalence across many ethnic groups, including Asian-Americans.
The study found similar rates of anorexia nervosa and binge-eating disorder among all ethnic groups. Researchers estimated:
- 0.10% of all Asians experience anorexia nervosa during their lifetimes
- 1.50% experience bulimia
- 1.24% experience binge-eating disorder
- 4.74% experience binge eating behaviors
Of those who experienced an eating disorder, Asian-Americans typically had the lowest rate of service utilization of any ethnic group. This means that Asian-Americans with an eating disorder are seeking help in smaller numbers than other groups.
Barriers to Treatment for the API Community
One significant barrier to treatment for people in the API community is that professionals may not recognize the symptoms of an eating disorder. Medical professionals are human, and they are vulnerable to stereotypes.
In one 2006 study, 91 clinicians read one of three case studies. The only difference between the case studies was ethnicity. Each study described the same disordered eating patterns. The clinicians were less likely to recognize eating disorder symptoms and recommend professional help when the subject wasn’t white.
Another barrier to treatment is how mental health treatment is perceived in the API community. In Ryann Tanap’s article on the National Alliance on Mental Illness (NAMI) website, “Why Asian-Americans and Pacific Islanders Don’t Go to Therapy,” Tanap discusses cultural perceptions about mental health:
There’s an underlying fear among the Asian-American and Pacific Islander (AAPI) community that getting mental health treatment means you’re “crazy.” If you admit you need help for your mental health, parents and other family members might experience fear and shame. They may assume that your condition is a result of their poor parenting or a hereditary flaw, and that you’re broken because of them. Seeking help from those outside the immediate family also conflicts with the Asian- and Pacific Islander-specific cultural value of interdependence. After all, why would you pay to tell a stranger your problems when you should be relying on the strength of your community?
These beliefs are reflected in SAMHSA’s statistics on mental health service use. Asian adults had the lowest rate of mental health service use out of any ethnic background. This reflects mental health service use for any reason, including eating disorder treatment.
Seeking help is further complicated by cultural tensions. In a 2014 article that was published in the Asian American Journal of Psychology, researchers reviewed narratives written by 109 Asian-American women. The participants all had concerns about their weight, their bodies, or eating. Some of the causes for these concerns included a cultural emphasis on thinness, family criticism of weight, and comparison to other Asian women. A 2015 article by the same researchers noted that second-generation Asian-American women reported significantly more disordered eating than their first-generation and third-generation peers. This indicates that another risk factor for eating disorders was bicultural stress and the perceived pressure to achieve.
People in the API community may face significant barriers to treatment. To find effective treatment, a good first step is looking for a culturally competent mental health professional or treatment center. NAMI recommends asking providers questions like:
- Are you familiar with my community’s beliefs around mental health?
- If you’re not, are you willing to learn and respect my point of view?
- Do you have experience treating people from my cultural background?
- Have you had training in cultural competency?
It also might require educating family members on eating disorders and mental health. It might require evaluating beliefs about success, managing stress, and body image. It might require a sometimes-frustrating level of self-advocacy to get needed treatment.
Everyone deserves culturally competent care. Places like Center for Discovery are available to provide you with the help you need.
Melinda Sineriz is a freelance writer and fat acceptance advocate. Read more of her thoughts on Twitter or visit her website to learn more.