Black Femmes & Eating Disorders

I'm not sure what it is that made me hold off posting this for so long. Was it my own history and background with disordered eating and body dysmorphia? Or had it been my wondering if maybe I was off on my hypothesis and Black women/femmes (and men/masc too) couldn't or wouldn't relate? IDK. but i'm very ready to pull the veil back on this issue now. Knowing about eating disorders, what drives them and what can worsen them, i've considered often lately how this quarantine has really aggravated and exacerbated eating disorders for all people all over the world.

As well, Black people's mental health definitely needs extra attention right now considering the way we've been getting hit left and right with police brutality and outright racism that leaves us murdered, in grief, and reeling from the trauma of it all... i figured it was time to stop brushing over an issue that i not only have worked extremely closely with but have some very personal and strong opinions about myself.

Eating Disorders, contrary to what popular culture may say, is NOT "a white girl issue" alone. In fact, eating disorders, while having a higher rate in people who identify as women, happen in every gender expression under the sun. People who identify as male have eating disorders in much higher rates than you would probably care to believe.

Also things that make people at higher at-risk for developing eating disorders so we know this isn't only based on an outdated 2-gender system?:

• People who identify as LGBTQ2+. Not because of anything inherent but more out of the trials and traumas faced by those in this group at a higher rate, feelings of non-acceptance by self, family, friends, or community, bullying, non-identification with their own body, mis-gendering, pressure from the community to appear a certain way, etc.

• People who have experienced emotional, physical or sexual trauma or childhood abuse or neglect.

• Child athletes (especially those in athletics that focus on body form or shape, appearance, or have weight requirements such as dancing, figure skating, gymnastics, wrestling, swimming, body building, etc).

• People with close relatives (especially parents or siblings) with a mental illness or physical or mental disability .

• People who are perfectionist or have a strong pull towards perfectionism.

• Youth dieters or those with a history of dieting.

• Youth living with or being in close proximity to relatives (especially parent or siblings) who have eating disorders.

• People from ethnic groups who have had to acculturate and 1st/2nd generation (those who immigrated themselves or with parents who immigrated). The push to "fit in" to western culture by adopting white ideals of success/beauty and rejecting their ethnic standards of body image or self image.

Overall, eating disorders and mental illness are extremely highly correlated - in fact, there has been a secondary diagnosis in all eating disorders i've treated in an inpatient setting as an ED therapist.

According to the National Eating Disorders website (NEDA.org), “at any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa”. This is not, I’m assuming, counting for those suffering from bulimia nervosa, orthorexia, or binge-eating disorder; all of which have their own diagnostic criteria. Then, there’s plain old disordered eating which in-itself can fly under the radar for a life-time and can lead to a more severe DSM diagnosis and/or to a very unhealthy relationship with food, exercise, body image, and self-esteem. According to surveys conducted by NEDA, in the US alone, more than 20 million women and 10 million men will have or have had an eating disorder within their lifetime.

You know what’s crazy? These are survey results – which means within the tested population, there are people that flat out lied. There is already massive under-reporting in eating disorders and outside of drug use, it may be one of the sneakiest disorders I’ve come into contact with. Eating disorders breed in secrecy and in that secrecy, the shame and skill in hiding the disorder grows. One can be extremely high functioning with an eating disorder – until they really, really aren’t…so excuse me if I don’t believe that the stats are fully encompassing of the actual numbers.

What’s SUPER crazy is that in the whole time I was working as a therapist for one of the few residential Eating Disorder Programs in the United States – I never once saw a black client who was there of their own fruition. The only black people I saw (and I could count them on one hand), were women! This is an issue by itself because the statistics clearly show that men can and do develop eating disorders at about a rate of 1:2 (men:women); but remember statistics and stigma heavily impact who will seek treatment or even admit to having an eating disorder. So where were the Black men?

At any rate, the Black women that I saw during my time with the program, came because they were serving in the military and the dysfunction from their disorder got so bad that it began to impede their job performance significantly. To get to us (an inpatient treatment center) a series of things had to have happened... a higher ranking officer noticed an issue, several steps were taken to treat the issue on base by a therapist, and the disorder persisted while their job performance declined. At that point is when the military “volun-told” them, as my military clients used to call it, to attend residential treatment. Basically, they used the term “voluntold” to describe how the military commanded them to attend treatment and how the patient would voluntarily sign-in to our program because it would have been disobeying a command to refuse said treatment. While the military is an institution that breeds eating disorders (don’t shoot the messenger), it’s wild to me that being in the military is one of the only ways eating disorders are caught or treated in the Black population. By the way, I also saw very few Latinos – one woman and one man, as I recall, also voluntold to begin treatment by the military. So this is totally a Black and Brown thing, if you were wondering.

Why is it that I did not see and treat more people that looked like me as civilians? ‘What is the barrier?’, I wondered over and over again? Because I knew the answer is not that Black people don’t have eating disorders. I know that we do. I know there are more women out there like me that have struggled or struggle so heavily with their bodies that they did destructive things to themselves - purged, over-exercised, gone on diet after diet, body shame themselves daily, used the guise of "better health" to restrict food intake severely and in an unsafe manner, etc. I know several Black women and Black men (and hell, several Brown people as well) who have had or do currently have a very disordered relationship with food, their body, and self-love. How can we not?

I know as a black woman, loving yourself is an act of resistance. Everything we hear and see and listened to growing up was telling us not to love ourselves, our hair, our body, our color. The average white woman lives in a culture where body shaming and selling you the next diet secret is a multi-billion dollar industry which is so pervasive that even white women have trouble loving themselves on a massive scale. But black women – tuhh! We get it from ALL angles! SO much so that a law had to be passed in 2019 to be able to wear our natural hair to work without fear of retribution. *Insert side eye here*. So much so that “going natural” is a thing because for so many years we did whatever we could to not have our hair natural. So many chemicals and lye and dye and Brazilian blowouts just to change and break our hair off and damage our physical health in the process. We aren’t even going to go into the traumatic effects of generational poverty, systematic disenfranchisement, and dysfunctional anti-black programming that we all have due to white supremacy here. But to be blunt, our very bodies hold a history of trauma due to the trauma our ancestors endured. In so many ways we carry the trauma of tens of thousands of women/femmes in our blood & bones. (Check out my blog post on inter-generational trauma for more on that note).

Trauma and eating disorders go hand in hand though. Just like eating disorders and lack of self-worth & negative thought patterns go hand in hand.

So then.. I ask myself…especially when i know we see and know trauma at disproportional rates being Black and Indigenous, why is it that I’ve seen so little black women/femmes in eating disorder treatment? Why have I seen no Black males in Eating Disorder treatment? I’ll tell you one thing, it’s not because we don’t need it.

It is because it was utterly inaccessible.

Because of the stigma surrounding mental health in our and most indigenous communities.

Because you need insurance – good insurance - to be able to have a therapist that can even refer you or help facilitate getting you into a residential eating disorder treatment program if that is the level of care you need.

Because although having a nutritionist as part of a multi-disciplinary team is best practices care, nutritionist costs are almost never covered by insurance.

Because you need time to search out a decent therapist that you resonate with to have a positive therapeutic experience.

Because of the lack of access to services.

Because of the lack of access to quality services.

Because of lack of funds to pay for those services even once gaining access.

Because of the difficulty of being seen as needing help or even being believed that they are suffering (that unfortunate strong Black woman rhetoric).

Because the insurance guidelines to be accepted to residential treatment are fat-phobic and focused on BMI/being underweight which discounts at least half of all those that could benefit heavily from treatment.

Because eating disorders don't just happen when someone is "under weight" but get noticed a lot less or even glorified in those who are average or over weight (see fat-phobic culture).

Because we don’t have the means or support or time to get ourselves adequate help because we are too busy "taking care of business" i.e. putting food on the table, working several jobs, getting degrees, taking care of everyone else we don't stop to notice or evaluate our own needs. We've pushed our own needs down so deep or to the side for so long that to neglect our needs has become normalized.

Because out of the whole hospital in a Black metropolitan area, I was the only Black therapist during the majority of my tenure… WHAT?! this part still enrages me...

There was no representation for us on either side. There was no understanding for us. Not within our own community about the issue and certainly not outside of that community. Black women/femmes aren’t “supposed” to having eating disorders, right? What, are we “too strong” for those too?

Most people are grossly uneducated about eating disorders, their prevalence among us, their impact, and the myriad of causes for them. Eating disorders can be a way to silence oneself. Punish one’s self. To feel good or expert at something. To numb one’s emotions so they don’t have to feel their crippling depression, anxiety, or replay their trauma again and again. To create control where one feels they lack control over their lives. It’s a way to feel smaller & take up less space. By the same token, eating disorders can be a way to make oneself invisible or "unappealing” by gaining weight, especially in our fat-phobic culture. This last example or ‘reason’ for an eating disorder is one I have heard from a lot of femmes who have survived sexual assault or sexual trauma. It becomes a way to hide in plain sight, essentially by making oneself larger and socially “undesirable” in hopes of lessening their chance of being targeted by predators. These are not the only reasons people develop or "need" their eating disorders. But i do hope it helps you to understand that vanity purposes or weight loss are not the only goals or reasons one may develop an eating disorder.

Now tell me who has shrunk more or had to shrink themselves more in this world than the Black woman/femme? Who has been the least protected in this world other than the Black woman/femme? Who has had less control over their very own sovereignty in this world other than Black people?

Eating disorders are so invasive because they seemingly "solve a problem" for the person with the ED. They convince the host to be quite about their pain, about their harmful habits. The shame of having an eating disorder soaks up the host like quicksand. When we are already soaked in shame for just being and holding this ancestral trauma and daily life trauma that is the unfortunate reality for too many Black girls, it’s too much saturation to even begin to talk about a problem dealing with food or weight. And although eating disorders have the HIGHEST morbidity rate of all other mental health disorders, it would seem that for most Black people, not eating or eating too much is the very least of their worries even if it is killing them. Killing us.

I won’t even talk about the level of misdiagnoses we experience as Black people in the mental health world and in the physical health realm. I’ll go into the studies of Black men being misdiagnosed as schizophrenic at a much higher rate than any other ethnicity when they are actually depressed or bi-polar in a future blog. I’ll share at another time how immigrant racial minorities are more frequently assigned a psychotic disorder diagnosis than native racial minorities of a similar background. I won’t talk about how Black women are dying during childbirth at alarming rates because physicians do not listen to us and ignore our pain, literally believing we feel less pain than our white counterparts. And I won’t even mention here, how cosmetics targeted to the Black demographic have more neurotoxins and endocrine disruptors than products targeting the White demographic…

What I will end on is what I realized as I was working as a therapist in that hospital. That although I truly loved what I did – I was never going to reach my people like that. The clients I saw were predominantly white women. I was often the only brown face in the whole room- both clinical staff and client. And mind you, the Eating Disorder Program shared a unit with the trauma program and still, I was usually the only brown face you could see on the unit. So, while I’ve known my purpose is to help Black and Brown people – the work I was doing there did not connect me to those Black and Brown people that really needed the help of a Black therapist.

We have to take it on OURSELVES to help ourselves and unfortunately or fortunately, I believe in the coming years, this will mean going outside of the powers that be and the regimes that were NEVER created for US, to seek and give help.

We have to be our own support system. We have to bring back and support black business, black healing, black community. This is why I have transitioned from a therapist in a system that is broken (or was never whole…) to a spiritual healer/wellness educator. I know my purpose is greater than helping only white women heal. Everyone needs healing but my community needs it most. From US. For US. And it’s time y’all. Black and indigenous women/femmes are dying and it’s being covered up or we don’t see it or we are lied to about the true causes.

It’s not that we don’t have eating disorders. It’s not that we don’t have trauma. It’s not that we aren’t here to help each other. We do. We are. I see you. I hear you screaming silently. There is help for us out there. We no longer have to stay silent. It’s time to scream. It’s time to take up space. It’s time to return to our roots in so many ways and heal.

With constant love &

in resistance,

Gabrielle Smith, MSW <3