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Article Excerpt
Eating disorders initially were considered to occur among young, White middle class women. However, during the last two decades, high rates of obesity-related symptoms (e.g., binge-eating) and obesity have been documented among African American women. Despite emerging findings about the presence of eating and health concerns among African American women, few counseling models of eating disorder symptomatology have included the socialization experiences of African American women. This paper examines, from a contextual perspective, the unique stressors that may contribute to eating disorder symptoms in African American women, implications for race and culture-specific counseling are discussed and recommendations for mental health counselors are presented.
INTRODUCTION
Eating disorders such as anorexia, bulimia, and binge eating disorder are considered major health concerns among women because they are associated with adverse mental and physical repercussions including depression, low self-esteem, suicide, obesity, infertility, and malnutrition (Polivy & Herman, 2002; Stice, 1999). It has been argued that more clinical and media attention has been given to the predominant eating disorders of anorexia and bulimia (Paul, 2003; Polivy & Herman, 2002). However, research findings suggest that African American women exhibit high rates of binge eating behaviors (Abrams, Allen & Gray, 1993; Gray, Ford, & Kelly, 1987; Smith, Marcus, Lewis, Fitzgibbon, & Schreiner, 1998; Striegel-Moore et al., 2003; Striegel-Moore, Wilfrey, Pike, Dohm, & Fairburn, 2000) and obesity (Davis, Clance, & Gailis, 1999; Foreyt & Poston, 1999; Smolak & Striegel-Moore, 2001). For instance, African American women in the United States have the highest prevalence of combined overweight and obesity (77.3%) (National Institute of Diabetes and Digestive and Kidney Diseases). Even so, traditional research and counseling approaches used to assess women's eating disorder symptoms do not necessarily incorporate the unique socialization experiences of African American women.
Several theorists have argued that African American women, as members of two low status groups (i.e., race and gender), may face additional stressors beyond the daily life stressors that all women face since they are being raised in a society where experiencing and internalizing racist, discriminatory, and prejudicial attitudes are potential realities (Clark, Anderson, Clark, & Williams, 1999; Constantine & Blackmon, 2002; Greene, 1994; Paul, 2003; Thomas, Witherspoon, & Speight, 2004). Furthermore, empirical evidence supports the notion that societal stressors such as racism are related to African American women's mental and physical health concerns (Clark et al., 1999; Paul, 2003; Thompson, 1997; Thompson & Neville, 1999; Wyatt, Williams, Calvin, Henderson, Walker, & Winters, 2003). Not surprisingly, African American women experience higher disease and illness rates and more chronic conditions (e.g., obesity, hypertension and diabetes) in comparison to their White counterparts (Davis et al., 1999; Leigh, 1995; Myers & Rodriguez, 2002; Smolak & Striegel-Moore, 2001).
According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), anorexia is defined as an eating disorder characterized by a person's refusal to maintain her or his body weight through use of excessive dieting and inaccurate perceptions of her or his body image based on an obsessive fear of becoming fat. Bulimia is characterized by a person's excessive rapid binging followed by purging through use of self-induced vomiting, laxatives, diuretics, restrained eating or excessive exercise. Binge eating disorder, a conditional diagnosis undergoing further empirical study, is defined by recurrent episodes of binge-eating that occur in the absence of regular use of compensatory behaviors such as purging (Streigel-Moore, Fairburn, Wilfley, Pike, Dohm, & Kraemer, 2005). Obesity refers to having a body mass index (BMI) of 30 or greater and/or weighing more than 20% above the upper limit for height (Davis et al., 1999).
While research concerning eating disorders in African American women has increased, the literature remains plagued with conceptual and methodological challenges (Lynch, 2004; O'Neill, 2003; Smolak & Striegel Moore, 2001). Considering the presence of eating disorder symptoms and high prevalence rates of overweight and obesity in African American women, it is imperative that researchers include African American women in their studies of eating disorder etiology. Furthermore, it is critical that counselors working with African American women become aware of, acknowledge, and understand the cultural and sociopolitical histories that contribute to African American women's psychological well-being.
The aim of this paper is to provide a contextual framework which examines the potential stressors contributing to eating disorder symptoms in African American women living in the United States. Next, theoretical and empirical support for these factors are discussed. Finally, recommendations for culturally competent counseling are provided. Although this paper focuses on the experiences of African American women, the counseling strategies discussed can be applied to other women belonging to oppressed demographic-identity groups.
POTENTIAL STRESSORS FOR AFRICAN AMERICAN WOMEN
In general, physical appearance such as body shape has been identified as a primary motivation for the development of eating disorders in White women (Smolak & Striegel-Moore, 2001). In fact, researchers have argued that the dominant White American cultural ideals and obsession with thinness have been the leading cause of the development of eating disorders in women (Brownell, 1991: Lynch. 2004, Polivy & Herman, 2002). For example, women who exhibit anorexia-type eating disturbances are habitually concerned with their weight and body image and engage in restrictive behaviors (e.g., severe dieting for weight loss) to control them (Herman & Polivy, 1980: Smolak & Striegel-Moore, 2001). However, African American women's standards of beauty may be based on a different set of body image criteria (Abrams et al., 1993; Akan & Grilo, 1995; Lynch, 2004; O'Neill, 2003; Polivy & Herman,...
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