The Invisible Struggle: Why We Need to Talk About Anorexia & Bulimia in Women of Color
There is a silent epidemic happening in our communities, and the medical system is largely failing to see it.
For decades, the cultural narrative around eating disorders has focused almost exclusively on thin, affluent white women. This stereotype creates a clinical blind spot that leaves millions of Black, Latina, Asian, and Indigenous women suffering without a diagnosis and without access to the care they need.
At Combahee River Integrative Psychiatry, we are committed to dismantling the myth that eating disorders are a "vanity issue" or a struggle reserved for a specific demographic. Clinical experience and research data tells a story of equal prevalence, but unequal care.
The Data: What the Research Actually Says
Contrary to popular belief, eating disorders do not discriminate based on race or class. In fact, for certain behaviors, women of color are more at risk.
Binge Eating Prevalence: Research indicates that recurrent binge eating is actually more common among Black women than white women, yet Black women are significantly less likely to receive treatment for it (Striegel-Moore et al., 2003).
The Diagnosis Gap: A landmark study asked clinicians to evaluate case studies of women with identical eating disorder symptoms. The result? Clinicians were significantly less likely to diagnose the Black women with an eating disorder compared to the white women, often attributing their symptoms to other causes (Gordon et al., 2006).
Bulimia Rates: Studies involving Latina and Black adolescents have shown that they are just as likely—and in some datasets, more likely—to attempt to lose weight through purging behaviors than their white peers (Goeree et al., 2011).
The science is clear: We are getting sick at the same rates. We just aren't being seen.
The "High-Functioning" Mask
For many women of color, an eating disorder doesn't look like "losing control." It looks like hyper-control.
We often grow up with the pressure to be the backbone of our families or the responsible daughters. We are taught that we must always be available to manage family crises while excelling in school and in our careers without support, and never show cracks in the armor.
In this context, food becomes a tool to manage the crushing anxiety of unrealistic expectations and perfectionism.
Restriction can feel like a way to maintain internal control or "discipline".
Binging can feel like the only safe way to numb out and rest after a day of performing for others.
Purging can feel like a way to "fix" a mistake and get back on track.
Because many of us continue showing up to work, meeting deadlines, and caring for others despite our struggles, our suffering goes unnoticed. We aren't seen as "sick." We are seen as "strong."
Eating disorders center around identity not vanity.
One of the biggest misconceptions I hear is that eating disorders are just about wanting to be thin or look a particular way. While body image plays a role, the root of disordered eating behaviors go much deeper.
In my own research published in the Journal of Psychiatric Research, "Neural processes related to negative self-concept in adult and adolescent anorexia nervosa" (Mendoza et al., 2021), we found that Anorexia Nervosa is deeply tied to "self-concept"—the fundamental beliefs you hold about who you are, your belief in your competence and how much you like yourself.
When you struggle with an eating disorder, your brain processes your own identity through a lens of negativity and relentless criticism.
For women of color, this is compounded by the world we live in. We navigate spaces that often tell us we are "too loud," "too much," not “feminine enough”, or "not professional enough." We often have to change the way we show up in conflicting environments, at home you must keep it together and be a backbone while being judged as not compliant enough at work. When your identity is constantly under attack or in flux, controlling your eating habits and body shape or size can feel like the only way to find solid ground, a way to conform to outside expectations or a way to avoid feeling judged or criticized.
Healing is a Radical Act
If you are reading this and recognizing yourself, I want to share 9 recovery tips:
You are not alone. You are deserving of care and of a loving connection with your body. All recovery starts with reaching for help, from a trusted friend, a family member, a therapist or your physical or mental health provider.
Trust your body and your ability to eat intuitively. Eating is an effortless, instinctive ability that every single person was born with. Don’t allow your eating disorder to convince you otherwise.
Recovery is possible. Start celebrating your small victories, reading this article means you are ready to face that disordered eating is causing you harm.
Be as kind to your body as you are to your friends. When you feel out of control, it is tempting to blame your body, judge it harshly or check your reflection constantly looking for “imperfections”. In the long run, this hostility towards your body keeps you stuck in a destructive cycle.
Find what motivates you. For some, its reclaiming their identity and not allowing perfectionism to drive their lives. For others, its the strong desire to live life on their own terms and not dictated by restriction, binging, and purging cycles.
Separate your voice from the eating disorder’s voice. For example:
Eating disorder voice
If I eat less, I will feel better
I did not exercise, so I must skip lunch
Skipping breakfast is good for me, it’s less calories in my day
Your own voice
I want to enjoy food with friends and family
My body needs carbs for energy
I can have dessert simply because I want it
I am hungry right now, so I must nourish myself
Whenever a thought to restrict comes up, ask yourself, “Is this my eating disorder, or is it really what I want”
Eat Regularly Even When It Feels Strange. Aim for breakfast, lunch, dinner, and one or two snacks a day. It is not a rigid rule. It is a guideline to help your body rebuild consistency and avoid the restrict and binge cycle. When your body is still healing, consistency helps regulate hunger signals and calm the chaos.
You are unique but your eating disorder is not. If I recovered and others have recovered, so can you. Take what resonates and leave what does not. Every time you challenge self-judgment, criticism, and unhelpful beliefs you show yourself compassion and are adding another piece to the puzzle of recovery. Over time, those pieces form the full picture.
Everyone’s recovery looks a little different, but there are some common elements. It’s rare to go at it alone. Usually it’s key to reach out for professional help whether that be working with a dietician, an eating disorder informed psychotherapist, a psychiatrist, and a support or therapy group.
At Combahee River, we practice Integrative Psychiatry. This means we don't just hand you medications and send you on your way. We work to help you understand harmful cycles and strengthen your mind/body connection.
We use psychotherapy to process the cultural and family pressures you carry. We use somatic (body-based) tools to help you feel at home in your body. And when necessary, we use medication to lower the volume of the obsessive thoughts so you can do the work of healing.
You do not have to carry this secret alone anymore. Your hunger for food, for rest, for understanding is valid.
Work With Us
If you are located in New York, New Jersey, or North Carolina and are ready to explore a holistic, culturally competent approach to eating disorder treatment, we invite you to connect with us.
Book a Free Consultation Here (Link to: https://www.combaheepsych.com/contact
References
Goeree, M. S., Ham, J. C., & Iorio, D. (2011). Race, Social Class, and Bulimia Nervosa. Iza Discussion Paper No. 5823.
Gordon, K. H., Brattole, M. M., Wingate, L. R., & Joiner, T. E., Jr (2006). The impact of client race on clinician detection of eating disorders. Behavior Therapy, 37(4), 319–325.
Mendoza, C. J., Palka, J. M., Pelfrey, S., & McAdams, C. J. (2021). Neural processes related to negative self-concept in adult and adolescent anorexia nervosa. Journal of Psychiatric Research.
Striegel-Moore, R. H., et al. (2003). Eating disorders in white and black women. American Journal of Psychiatry, 160(7), 1326–1331.
