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The importance of intersectionality in eating disorder treatment and research

Eating disorders affect people of all genders, sexual orientations, races, cultures, weights, sizes, and ages. However, a common misconception is that eating disorders only affect thin White, middle and upper-class girls, women, and young men.

This harmful myth stigmatizes people who don't belong to this demographic, causing fat people, queer and transgender people, intersex people, people of color, and those who sit at the intersection of several marginalized groups to be severely underdiagnosed and undertreated.

8
 minute read
Last updated on 
May 31, 2023
What is intersectionality?
In this article

What is intersectionality?

At its core, intersectional theory refers to how systemic inequality based on class, gender identity, sexual orientation, ethnicity, race, disability, and more interact, creating systems of disadvantage and discrimination. As such, our identities do not exist in a vacuum; they always affect each other. 

Intersectionality was first coined by legal scholar Kimberlé Crenshaw (Distinguished Professor of Law at Columbia Law School and UCLA School of Law) in 1989 to explain how systems of oppression intersect and cause unique experiences for those with more than one marginalized identity due to racial and cultural hierarchies.

"We tend to talk about race inequality as separate from inequality based on gender, class, sexuality, or immigrant status. What’s often missing is how some people are subject to all of these, and the experience is not just the sum of its parts."

- Kimberlé Crenshaw

Crenshaw's initial focus was on Black women, whose discrimination and oppression are uniquely tied to the intersection of racism and sexism. These two things cannot be separated or considered in isolation.3

Multiple social identities influence one another and can increase the risk of discrimination, disparity, and discrimination. An intersectional approach to eating disorders acknowledges that holding two marginalized identities exponentially increases the risk of developing an eating disorder. Essentially, the risk is far greater than the risk of either identity on its own.4

How intersectional discrimination applies to eating disorders

Historically, eating disorder research has lacked an intersectional approach, but in recent years, researchers have begun to examine how eating disorders affect people of all races, sexualities, genders (including overlapping social identities), and those who occupy multiple marginalized identities.

This research can highlight the need for tailored, culturally-responsive treatment that considers a person's unique needs and risk factors. However, more intersectional research must be conducted to improve treatment and preventative care for high-risk populations.4

More intersectional research must be conducted to improve treatment and preventative care for high-risk populations.

Dangers of eating disorder misconceptions

Unfortunately, treatment providers aren't always as culturally-responsive, inclusive, and trans– and queer-informed as they should be. At Within, we strive to be different

Learn about the world-class care you'll receive at Within
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Below are a few dangers that can result from eating disorder misconceptions when intersectionality and inclusion are not prioritized at care facilities. 

Black people are less likely to be diagnosed with eating disorders

Research shows that people of color, especially Black people, are far less likely to receive treatment for eating disorders due to racial discrimination. Consider the following eye-opening statistics:5

  • Hispanic teens are more likely to have bulimia nervosa than non-Hispanic peers.
  • Compared to white teens, Black adolescents are 50% more likely to engage in binging and purging.
  • Binge eating disorder disproportionately affects people of color.
  • People of color who self-reported disordered eating were less likely than white patients to have been questioned by a doctor about eating disorder symptoms.
  • Nearly 50% of Indigenous teens report attempting to lose weight.

Research also shows the lack of inclusiveness and culturally responsive care from doctors. When given identical case studies depicting disordered eating symptoms in women of color, specifically Hispanic, White, and Black women:

  • 44% of treatment providers identified the white woman's behavior as problematic
  • 41% determined the Hispanic woman's behavior was problematic
  • 17% determined that the Black woman had a problem with disordered eating

The treatment providers in the study were also less likely to refer the Black woman to professional eating disorder treatment.5

If you are a therapist reading this, know that racial biases still exist in the medical community, so practicing anti-racism in treating eating disorders is important. 

Transphobia in the medical community

Transgender and non-binary people experience significant transphobia in medical settings. Many healthcare professionals do not receive trans-informed training or education and thus are not literate in trans medicine, while others may openly discriminate against trans patients.

Transphobia may include being deadnamed, which is calling someone by the name they had before they transitioned, or being misgendered during treatment and excluded from care, such as a trans woman being excluded from a "women-only" group.12

Additionally, trans people experience other barriers to high-quality care, such as:7

  • Mental health challenges
  • Inappropriate electronic forms or records
  • Lack of income or insurance
  • Lack of stable housing or transportation

An intersectional approach can reveal why trans people may experience these barriers to care. Trans people, particularly trans women of color, are more likely to be denied housing than cisgender people. In fact, 50% of transgender individuals have experienced homelessness.8 Transwomen of color experience many forms of discrimination, such as racism, transphobia, and transmisogyny. These compounded increases the risk of disparity and various mental health conditions like eating disorders.

Intersectionality

Fatphobia and weight stigma among healthcare professionals

The medical community fails people with eating disorders in many different ways. For example, fat people who have an eating disorder often do not receive the care they need. Their symptoms and disordered eating behaviors tend to go unrecognized, underdiagnosed or misdiagnosed, often ignored by treatment providers.6

Disordered eating behaviors amongst fat people often go unrecognized, underdiagnosed, misdiagnosed, and ignored.

This is due to fatphobia and weight stigma amongst healthcare professionals and incorrectly equating "thinness" with "health."6

Fat people may leave a doctor's office with a prescription to "diet and exercise regularly" instead of receiving much-needed eating disorder treatment if they have an eating disorder. This can create a cycle of shame and guilt, as dieting is ineffective at producing long-term weight loss. The shame around weight felt at the doctor's office can also cause people to avoid going to the doctor in the future, which can leave other conditions undiagnosed, increasing the severity and progression of the disease.9

Although all fat people experience discrimination, when taking an intersectional approach to treatment, it's important to remember how other identities, such as Blackness and trans experience, may amplify discrimination.

Ignorance about intersex bodies and experiences 

Although most biology classes focus on human sexuality as a binary determined by sex chromosomes, many people are intersex, meaning that they have sex characteristics that fall outside of the male/female binary. Depending on which sex trait variations are included, between 1.7 and 5% of the population falls under the intersex umbrella.10

Very few studies have focused on eating disorders in intersex populations. Still, research has shown a higher rate of psychiatric disorders in intersex people than in the general population.11

Very few studies focus on eating disorders in the intersex population, even though up to 5% of the population falls in this category.

Many doctors, therapists, and eating disorder professionals know very little about intersex people's bodies and experiences and may be unable to provide appropriate medical and mental health support to facilitate recovery. This may result in inaccurate assessments of where an intersex patient's hormones, fertility, bone density, and body composition might fall in recovery and lack of appropriate support for medical trauma or bullying that intersex people often experience.

Intersex people may also experience alienation in treatment settings that center on the experiences of cisgender women and present a narrow version of body positivity that doesn't include their experiences. 

Misconceptions can prevent early detection and intervention 

Despite the knowledge that eating disorders can affect people from all demographics, thanks to pop culture and the media, many people still picture a thin White cis girl when they think of someone with an eating disorder. As a result, those who don't fit this stereotypical image of someone with an eating disorder may feel ashamed about their condition or falsely believe that their disordered eating is not a problem. 

Research has shown that early detection and treatment significantly improve treatment outcomes for those with eating disorders. For example, when teens with anorexia nervosa (AN) receive family-based interventions within the first three years of eating disorder onset, they are much more likely to recover.1

Early diagnosis and quality care can also prevent a person's eating disorder from progressing, causing severe and potentially life-threatening consequences.2 Providing inclusive intersectional care allows for early detection to happen.

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The future of intersectional eating disorder research and care

The risk of these dangerous and harmful consequences highlights the need for an intersectional approach to eating disorder research, diagnosis, and treatment, in which people sitting at the intersection of several marginalized identities can receive inclusive and informed care.

Additional intersectional research on eating disorders and many intersecting marginalized identities is needed. It will help researchers, clinicians, and patients understand the individualized care needed for intersectional care. 

Knowing symptoms that affect specific groups over others can help professionals make much-needed modifications to eating disorder assessment tools and treatment interventions. This will increase eating disorder recognition and diagnosis and improve prevention for high-risk groups and individuals. An intersectional approach is the way forward to create a safe and inclusive environment for all people struggling with eating disorders.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Treasure, J., & Russell, G. (2011). The case for early intervention in anorexia nervosa: Theoretical exploration of maintaining factors. The British Journal of Psychiatry, 199(1), 5-7.
  2. U.S. Department of Health and Human Services. (n.d.). Eating disorders: About more than food. National Institute of Mental Health. Retrieved February 17, 2023.
  3. Kimberlé Crenshaw's intersectional feminism - JSTOR Daily. (n.d.). Retrieved February 17, 2023.
  4. Burke, N. L., Schaefer, L. M., Hazzard, V. M., & Rodgers, R. F. (2020). Where identities converge: The importance of intersectionality in eating disorders research. The International Journal of Eating Disorders, 53(10), 1605–1609.
  5. People of color and eating disorders. (2018, February 26). National Eating Disorders Association. Retrieved February 17, 2023.
  6. Veillette, L. A. S., Serrano, J. M., & Brochu, P. M. (2018). What's Weight Got to Do With It? Mental Health Trainees' Perceptions of a Client With Anorexia Nervosa Symptoms. Frontiers in Psychology, 9, 2574.
  7. Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 168–171.
  8. The crisis of transgender homelessness. (n.d.). Retrieved February 17, 2023.
  9. Chastain, R. (2022, April 16). Myths about the failure rate of dieting. Myths About the Failure Rate of Dieting. Retrieved February 15, 2023.
  10. Costello, D. C. G. (n.d.). Hypospadias: Intersexuality and gender politics. The Intersex Roadshow. Retrieved February 17, 2023.
  11. Falhammar, H., Grinten, H. C.-van der, Reisch, N., Slowikowska-Hilczer, J., Nordenström, A., Roehle, R., Bouvattier, C., Kreukels, B. P. C., Köhler, B., & on behalf of the dsd-LIFE group. (2018, March 1). Health status in 1040 adults with disorders of sex development (DSD): A European Multicenter Study. Endocrine Connections, 7(3), 466-478.
  12. Intersectionality: What is it and why it matters. (2021). The University of British Columbia. Retrieved March 7, 2023. 
  13. Bernstein, M. (2005). Identity Politics. Annual Review of Sociology, 31, 47-74.

FAQs

Why is intersectional theory important?

Intersectionality recognizes that oppression (e.g., racial oppression) exists and can result in the unjust treatment of those in marginalized communities and intersecting identities. It is a theory that promotes social justice and is an integral part of the feminist movement.

An intersectional approach to eating disorder treatment ensures that those with specific identity markers are not discriminated against and receive the same treatment as others.12

What is identity politics?

Identity politics is when a group of people from a specific group develop political agendas based on these identities. These identities could be based on race, gender, social background, sexual orientation, nationality, etc.

Identity politics is deeply rooted in the idea that some groups are oppressed and discriminated against.13

Further reading

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Further reading

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