You may have heard stereotypes about eating disorders such as bulimia nervosa and who they affect. Many people wrongfully assume that only upper-class white women suffer from bulimia — but in reality, that could not be farther from the truth.

The patient population that suffers from bulimia nervosa is as racially and ethnically diverse as the U.S. population. Furthermore, not every bulimia patient identifies as a cis-gendered woman. Men and transgender individuals are also suffering from bulimia at increasing rates.

As you can see, many of the stereotypes associated with eating disorders like bulimia nervosa are incredibly flawed. Thus, we wrote this blog post to help you better understand the diversity within the population of patients with bulimia and how that diversity impacts recovery, including access to treatment.

Bulimia, Race and Ethnicity

Diverse racial and ethnic groups suffer from bulimia nervosa. In fact, statistics suggest that racial and ethnic minorities are actually more likely to develop eating disorders like bulimia than their white peers. Below, we explore how bulimia affects people of color in the United States and why racial and ethnic minorities suffer from eating disorders at higher rates than white Americans.

Bulimia in the Black Community

With the advent of the Black Lives Matter movement, recent years have seen an increased focus on how Black Americans are disproportionately affected by many adverse experiences. This includes eating disorders: Black teenagers are 50 percent more likely to exhibit bulimic behaviors, such as binging and purging, than their white peers.

Women of color appear to be especially affected by eating disorders such as bulimia. Theories of why this occurs focus on stressful experiences like abuse and racism, as well as generational trauma resulting from the history of slavery and racism in our country. This is why Black Americans can’t just “get over” slavery and other phenomena; the historical trauma is carried across generations through subconscious nonverbal cues passed down from parents to their children.

Yet despite the fact that Black women are more likely to suffer from eating disorders, they are less likely to receive professional help. Doctors often fail to recognize eating disorders in women of color, even when they self-report symptoms like binging and purging. One study found that Black women who reported eating and weight concerns were less likely to be asked about them by doctors, while another found that only 17 percent of doctors identified eating disorder behaviors as problematic in case studies of Black women. The same study also found that clinicians were less likely to recommend Black women receive professional help for their concerns, revealing discrepancies in access to eating disorder treatment across racial minorities.

Bulimia in the Latinx Community

Youth from most racial and ethnic groups appear to diet at similar rates, but some minorities are more likely to develop bulimia nervosa than others. In particular, Hispanic teens are significantly more likely to suffer from bulimia than their non-Hispanic peers — which is especially important given that Hispanic individuals are currently the largest racial and ethnic minority group in the United States.

Acculturation may play a large role in the prevalence of eating disorders in the Latinx community. American culture places a harmful emphasis on thinness and appearance as outward measures of self-worth. As Latinx individuals struggle to adjust to life in the United States, they may find themselves in conflict when American beauty standards differ from those valued in their places of origin. This so-called “acculturative stress” is associated with increased rates of disordered eating among Latinas, especially when it comes to bulimic behaviors like binging and purging.

Bulimia in the Native American Community

As we mentioned previously, most racial and ethnic groups appear to diet at similar rates — but the Native American community presents an exception. In one study, nearly half of Native American youth reported being on a diet at the time they were surveyed, representing a potentially higher prevalence of eating and weight concerns in this minority group.

The United States recognizes over 500 Native American tribes, yet finding a sample size large enough to study presents a challenge to understanding how eating disorders affect this minority. One of the first studies of eating disorders in this population, conducted in Connecticut in 2011, found no difference in the rates of disordered eating behaviors between white and Native American populations, contradicting the stereotype that eating disorders only affect white women.

According to the researchers behind the study, its results came as a bit of a shock to the local Native American population, who previously hadn’t realized the severity of disordered eating within their community. This presents a significant challenge to recognizing eating disorders like bulimia in Native American patients, who are already less likely to be asked about eating disorder symptoms than their white peers and less likely to seek treatment themselves (potentially due to stigma).

Treating eating disorders in Native American populations may also be more challenging, given the importance of food in Native American culture. Among many Native American tribes, food is a form of caregiving and an expression of love, presenting unique cultural concerns to providers treating behaviors like binge eating in Native American patients.

Bulimia, Sexual Orientation and Gender Identity

Heterosexual, cis-gendered women form the stereotypical image of an eating disorder patient — but the real picture of who suffers from eating disorders like bulimia nervosa is much more diverse. Both biological sex and gender identity play an important role in how eating disorders are recognized and treated in patients. Furthermore, the LGBTQ+ population is of particular concern to researchers and treatment providers, since as early as age 12, gay, bisexual and transgender teens face a significantly higher risk of binge eating and purging than their heterosexual peers.

Bulimia in Men

People tend to think of eating disorders as a woman’s disease, when in fact, one in three people suffering from an eating disorder identifies as male. Additionally, subclinical eating disorder behaviors — including binging and purging — are equally as likely to occur in male patients as in female patients.

It’s important to note that the body image concerns that drive eating disorder behaviors tend to differ between men and women, as cultural standards of beauty affect men and women differently. The ideal male body image is lean and muscular, meaning men may attempt to “bulk up” while women try to slim down. Studies support this assessment; as much as 90 percent of teenage boys have exercised with the goal of gaining muscle, and one-quarter of normal weight males perceive themselves to be underweight.

As in women, competitive athletics may also drive eating disorder behaviors in some men. For example, sports in which athletes compete in various weight classes, such as wrestling or boxing, may drive men to rapidly gain or lose weight in preparation for their next competition, so they can compete in the weight class their coach deems ideal. Such men may use unhealthy means of weight control, such as purging or laxative abuse, to achieve their athletic goals.

Unfortunately, despite the increasing prevalence of eating disorders in both genders, men are less likely to seek and receive treatment for an eating disorder than their female counterparts. The stereotype that eating disorders are a woman’s disease may lead doctors to overlook eating disorder symptoms in their male patients. Men might also be embarrassed that they are suffering from a problem they deem to be feminine or “gay,” discouraging them from discussing their concerns with a medical professional.

Bulimia in the LGBTQ+ Community

LGBTQ+ individuals face a significantly higher risk of developing an eating disorder than their heterosexual peers, owing in no small part to the environmental and cultural stress of belonging to a sexual minority. In addition to discrimination on the basis of their sexual orientation, LGBTQ+ people may face rejection from family and friends, bullying, gender dysphoria, homelessness and increased body scrutiny that contribute to the risk of developing an eating disorder.

A sense of belonging to the gay community, however, appears to have a protective effect against eating disorders — and LGBTQ+ youth centers, gay-straight alliances and other community organizations have created more safe spaces for LGBTQ+ individuals to find this sense of belonging, as well as to access mental health resources.

Bulimia in Gay, Lesbian and Bisexual Patients

Research, unfortunately, remains limited on eating disorders in the LGBTQ+ population; however, what we do know about eating disorders among LGBTQ+ individuals suggests that they are disproportionately affected by bulimia. Both LGBTQ+ men and LGBTQ+ women are especially impacted by bulimia nervosa.

Gay males appear to be of special concern in the population of eating disorder patients. While gay males represent only five percent of the overall population, 42 percent of men with eating disorders identify as gay. Gay males are also seven times more likely to report binging and 12 times more likely to report purging than their heterosexual peers. It is thought that gay men may suffer from eating disorders at higher rates due to high pressure to maintain the ideal body within the gay community.

Females who identify as lesbian, bisexual or “mostly heterosexual” also appear to suffer from bulimia nervosa at higher rates than those who do not. Non-heterosexual females were twice as likely to report binge eating within the last month than their heterosexual peers. Researchers also discovered elevated rates of purging via vomiting or laxative abuse among LGBTQ+ females.

Bulimia in Transgender Patients

Most people’s gender identity matches their biological sex, but in some cases, people feel they belong to the opposite gender than that they were born into as children. This leads to gender dysphoria, or a disconnection between the way people think of themselves and the way they look. Identifying as transgender and choosing to live out one’s life in a gender identity that matches the way one feels inside can assuage feelings of gender dysphoria. However, the transgender community appears to suffer from eating disorders at higher rates than their cis-gendered peers, owing in part due to feelings of gender dysphoria.

Gender dysphoria is common among those who identify as transgender and may lead to the use of unhealthy eating disorder behaviors to control one’s weight and/or appearance so it better aligns with a person’s gender identity. For example, transgender people may restrict calories, exercise excessively, purge or abuse laxatives in an attempt to manipulate their bodies into better matching their gender identity. Transgender females may do so to achieve a more feminine appearance, while transgender males may do so to suppress secondary sex characteristics and menstruation, according to Penn Medicine News.

As a result, transgender teens are four times more likely to report a diagnosis of anorexia or bulimia, nine times more likely to take diet pills and seven times as likely to use laxatives to control their weight as their cis-gendered peers. Increasing access to gender-affirming treatments like hormone therapy and gender reassignment surgery may help decrease feelings of gender dysphoria and therefore the need to control one’s appearance through unhealthy weight control methods; however, some transgender individuals may express a strong desire to live out their lives in accordance with their gender identity without seeking medical care.

Accessing Bulimia Treatment as a Minority

Those who belong to a racial, ethnic or sexual minority may face increased obstacles to accessing eating disorder treatment. They may struggle to have their condition recognized by doctors due to the fact that they do not match the stereotypical profile of an eating disorder patient. Or, they may face socioeconomic obstacles to eating disorder treatment, such as a lack of health insurance or the affordability of care.

Regardless, it’s important to recognize that treatment for eating disorders like bulimia nervosa dramatically improves patient outcomes. As a result, patients suffering from eating disorders should recognize that while it can be incredibly difficult to seek care for their condition, doing so will allow them to live a healthier, happier life in the long term. Here at The Meadowglade, we pride ourselves on providing patients with culturally sensitive eating disorder care that takes factors like race, ethnicity and gender identity into consideration. Contact our treatment center today to begin receiving help for bulimia nervosa.