Treating Asian American Women With Eating Disorders: Multicultural Competency and Empirically Supported Treatment

Abstract

Disordered eating and body dissatisfaction are occurring among Asian American women, but the vast majority of treatment literature is based on White Western women. Empirically supported treatments are increasingly encouraged for eating disorders, but therapists find little guidance for implementing them in a culturally sensitive manner. This paper reviews eating problems in Asian American women and explores concepts important to cultural competency in therapy. Examples of how cultural adaptations could be made to an empirically supported treatment are illustrated in a case scenario using aspects of C. G. Fairburn's Enhanced Cognitive Behavioral Therapy for Eating Disorders (2008).

Disordered Eating in Women of Color: Some Counseling Considerations

“…Furthermore, there is a belief that the increased presence of racially and ethnically diverse celebrity role models in the media may contribute to a rise in the rates of body and eating disturbances among children and women of color (Chao et al, 2008; Kempa & Thomas, 2000; Phan & Tylka, 2006; Smolak & Striegel‐Moore, 2001). The majority of eating disorder research reports have focused on a comparison between African American and European American women, with Asian American and Latina women consistently receiving little or no attention (Arriaza & Mann, 2001; George & Franko, 2010; Smart, 2010b). The underrepresentation of Asian American and Latina women in the eating disorders literature may lead to the lack of diagnosis or treatment for these women who present with eating and weight concerns.…”

“…This review of the literature seems to indicate that going through the acculturation process may create additional stressors in the lives of women of color, which could potentially lead to the development of eating disorders. This stress can be exacerbated when individuals experience conflict between the values of the different cultures (Kempa & Thomas, 2000; Root, 2001; Smart, 2010a, 2010b). However, it should be noted that many inconsistencies exist among these research findings, which can be partially explained by the conceptualization and measurement of acculturation (Warren et al, 2010).…”

“…First, counselors should be aware that there are many potential barriers to mental health care among women of color based on their sociopolitical histories and cultural beliefs. For example, research suggests that women of color may underutilize treatment services for eating disorders because of a lack of financial resources or insurance, strong distrust of the mental health system, fear that others may not be able to help, lack of awareness of resources, and feelings of shame and stigmatization (Alegria et al, 2007; George & Franko, 2010; Kempa & Thomas, 2000; Nicdao et al, 2007; Smart, 2010b). Therefore, the provision of health education workshops in local schools, community centers, and religious organizations may be a culturally appropriate method of providing access to useful resources for women of color (Story et al, 2003).…”

“…Second, it is imperative for counselors to understand culture‐specific themes and worldviews in the lives of women of color (Kempa & Thomas, 2000). This includes the need for achievement and perfectionism in Asian American cultures and the stigma surrounding mental health disorders in Asian Americans, which could be why few Asian American women seek treatment for eating disorders (Kempa & Thomas, 2000; Smart, 2010b; Sue & Sue, 2008). For Latinas, traditional gender roles, religiosity, and the notion of simpatia (creating conflict‐free situations) may be relevant in understanding why and how Latina women present with eating disorders (Kempa & Thomas, 2000).…”

“…Empirically established risk factors associated with eating disorders (e.g., body dissatisfaction, drive for thinness, thin‐ideal internalization, dietary restraint) may be the explanation for the lack of attention given to women of color in the eating disorders literature (Grabe & Hyde, 2006; Shaw, Ramirez, Trost, Randall, & Stice, 2004; Smolak & Striegel‐Moore, 2001). Because women of color may have different cultural standards of beauty (Kronenfield et al, 2010; O'Neill, 2003; Polivy & Herman, 2002; Rucker & Cash, 1992; Smart, 2010a, 2010b; Smolak & Striegel‐Moore, 2001), the emphasis on drive for thinness in traditional eating disorder models may be inappropriate when understanding, assessing, treating, and preventing eating disorders in women of color. In fact, the limited existing empirical research focused on women of color has shown that multiple contextual factors (e.g., acculturation, racial identity, intersection of race and gender) may have an effect on why and how women of color struggle with their eating behaviors and weight (Polivy & Herman, 2002; Pumariega, Gustavson, Gustavson, Motes, & Ayers, 1994; Rucker & Cash, 1992; Smolak & Striegel‐Moore, 2001; Wood & Petrie, 2010).…”