The 9th Annual Veritas Collaborative Virtual Symposium on Eating Disorders creates space for our community of experts and other leaders in the field to come together as a community and advance our understanding of what it means to provide best-practice eating disorder care to diverse populations. Our Symposium Speaker Series offers an introduction to the keynote presenters and topics that will be examined in greater detail at the virtual Symposium.
Charlynn Small, PhD, LCP, CEDS-S, is Assistant Director for Health Promotion at the University of Richmond’s Counseling and Psychological Services (CAPS) in Virginia. Dr. Small is a member of the board of directors of the International Association of Eating Disorders Professionals (iaedpTM). She has spent much of her career advocating for greater awareness of eating disorders among Black women and other people of color. Her co-edited anthology, Treating Black Women with Eating Disorders: A Clinician’s Guide (Routledge, Taylor & Francis) is slated for release in July 2020. We recently sat down with Dr. Small to discuss treatment considerations for Black people with eating disorders, including barriers to care, and the impact of their lived experiences on those disorders.
Veritas Collaborative: This year’s Symposium theme highlights the need for all of us in the field to recognize and understand the unique needs of diverse populations. What do we know about eating disorder prevalence among Black women, in particular?
Dr. Small: Unfortunately, we don’t have accurate numbers on the prevalence. In addition to the fact that relatively few studies have been conducted on these groups, a number of factors contribute to the inaccuracies. Sociocultural models of eating pathology suggest that Black women are well-protected from eating disorders, clinical approaches to classification, conflicting research outcomes, and the extant measures for assessing symptoms and risk factors contribute to the inaccuracies. The challenges with determining the accurate prevalence of the disorders in these groups is complicated by the fact that Black women are not monolithic. They represent a number of diverse cultural backgrounds including Black Americans, Black Haitians, Black Cubans, Black Jamaicans—and more. We’re talking about distinct cultures, traditions, communities, and concerns. However, despite these differences, my experience treating Black women has shown binge-eating to be the eating disorder they struggle with the most as a group.
Veritas Collaborative: The fact that we know so little about Black people and eating disorders really highlights the need for visibility, not just in terms of clinical research, but also through a shared cultural understanding that eating disorders don’t discriminate. Historically, eating disorders have been associated with White females. Today, we know better, but how has the historical lack of visibility impacted Black women and men struggling with eating disorders?
Dr. Small: People have been conditioned to associate eating disorders with, thin, affluent, young White women. Black people are largely absent from the visual for a number of reasons. As noted above, sociocultural theories predict that women of color have a lower risk for eating disorders. The ideas that Black women embrace larger, more attainable body ideals, and that their men typically prefer fuller, more voluptuous figures underlies this belief.
Further, until relatively recently, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) focused more on food restriction, leaving Black people, who tend to grapple more often with binge eating disorder, firmly on the margins of eating disorder diagnoses and treatments. Fortunately, the DSM-5 now recognizes binge eating as a diagnosable eating disorder.
Veritas Collaborative: It’s easy to see how the historical lack of visibility has created barriers to care for Black men and women—people can’t access treatment when they can’t receive a diagnosis. What are some of the other barriers to care facing this group? Are there cultural barriers, as well?
Dr. Small: Let’s do talk about the barriers that Black women and men must overcome on their way to treatment—and to be clear, many don’t make it to treatment. Of course, there are the obvious, systemic barriers such as a lack of financial resources and access to reliable, quality healthcare. However, we cannot discount the impact that trauma and lived experiences bring to the equation. Black children experience disproportionate rates of adverse childhood experiences that frequently impact eating patterns. However, because it is often considered “taboo” to discuss these concerns within our communities, they go unaddressed. For example, Black children are twice as likely as White children to have experienced sexual trauma which is highly correlated with binge-eating. Narratives and cultural experiences matter—and are associated with eating disorders within these groups. Unfortunately, they aren’t always addressed in a meaningful way in some doctor’s offices.
Veritas Collaborative: That raises an important question: How can practitioners and other healthcare professionals support Black women and men in general, and in their practices?
Dr. Small: Initiate the difficult conversations. The hard questions must be incorporated into their assessments. It is one of the most effective ways to support Black people who seek care. Many White and other non-Black practitioners are failing to identify eating disorders in Black women and men because they are fearful of having these difficult conversations about the correlations between systemic oppression, behavior, and health outcomes within this population.
A Black mother, for instance, might seek medical assistance feeling overweight and sluggish. Yet often, the conversation inevitably focuses on weight management or the risk of metabolic conditions, like diabetes. Certainly, those are important topics to explore, but without a substantial dialogue about systemic oppression, or other important topics, practitioners may miss key insights that can only come from listening to and understanding their patients’ lived experiences. These insights may have important implications for diagnosis and treatment.
An honest conversation with the hypothetical Black mother in our example could reveal nightly binge-eating sessions because she is coping with the fear and anxiety that her teenage son might not make it home safely from his extracurricular activities or hanging out with friends. These are legitimate concerns about her family’s safety—and she could be grappling with an eating disorder as a result.
Veritas Collaborative: We believe in the power of conversation to create better outcomes and a better world for everyone. How have recent events changed the conversation about eating disorders and Black women and men? Are you hopeful for lasting positive change?
Dr. Small: A colleague and I have spent the past five years speaking about these issues at every opportunity. During these times, it’s easy to discern when people are uncomfortable or don’t want to talk about race. However, because of recent social unrest, the renewed movement for racial justice has amplified the fact that it is critical that we engage in these difficult conversations. I’m hopeful that we will continue to have them.
Veritas Collaborative: We are honored to have the opportunity to continue this important conversation with you at our 9th Annual Symposium in September., Can you share the one thing you want attendees to take away from your keynote presentation, “It Takes the Whole to Make Us Whole: Treating Black Women with Eating Disorders?”
Dr. Small: I want people to understand the lasting impact of intergenerational trauma. The relationship that Black people have with our bodies is complicated by our collective histories and our personal histories. Our lives matter—and so do our lived experiences.
Changing the field of eating disorder treatment for the better—for everyone—starts with advancing your knowledge of best-practice care for diverse populations. Register today for Veritas Collaborative’s Virtual 9th Annual Symposium on Eating Disorders to tap into the collective knowledge of our community of experts and leaders in the field and earn up to 26.0 continuing education credits.