The first time Grace* forced herself to throw up, she was 19 and recovering from a painful breakup. After a long summer of calorie counting and subsisting solely on a diet of fruit, vegetables and tofu, Grace found herself “jonesing badly for pizza.” That afternoon, she gave in to her craving and went on a binge she immediately regretted.
“I took the back of my toothbrush and threw up the pizza in one swooping puke,” said the 5’2”, 120-pound Korean American, who wears a size 2. “It was difficult to silence the gagging noise, but my parents and my brother were at home so I must have been desperate to get it out of my body.”
Grace is not alone. She is one of millions of young women across America who struggle with eating disorders—an estimated one in five women have disordered eating, according to the National Institute of Mental Health, with 90 percent of those between the ages of 12 and 25. Yet even with these numbers, Asian American women in particular may often feel ignored in the national discussion.
Not just a “white woman’s issue”
From Kelly Taylor’s diet pill abuse on “ Beverly Hills, 90210 ” to DJ’s excessive workouts on “ Full House ” to Blair’s bulimia on “ Gossip Girl ,” eating disorders have traditionally been portrayed on network TV as a problem that only affects young, middle- to upper-class, Caucasian women.
“It’s meaningful that a white woman can turn on a TV and find a broad range of characters, but Asian Americans are portrayed the same way over and over again,” said Dr. Teresa Mok, a clinical psychologist who treats a lot of college students. “For someone struggling with self-esteem issues, this reinforces the feeling of invisibility.”
Eating disorders are often seen as a “white woman’s issue,” she says, a stereotype reflected in the lack of research on this topic among women of color. And interestingly, race not only ties in to how eating disorders are portrayed, but also how they develop. From the Asian American clients she sees at her private practice in Urbana, Ill.,Mok discerns a common theme that lies at the root of many eating disorders, albeit subconsciously.
“It’s not just about weight. There’s always a racial component to it,” she said. “There’s a general body dissatisfaction with eye shape, hair color, breast size, nose,” but, she added, “No client [overtly] says, ‘I want to be white.’”
The pursuit of Western beauty ideals often plays a large role in the development of disordered eating habits, with the media subliminally urging women to want all of the aforementioned physical features – the image on most magazine covers at the checkout aisle.
Dr. Sand Chang, a clinical psychologist who teaches intercultural awareness development at the California School of Professional Psychology, said people who don’t seem themselves “reflected in what is seen as ‘normal’ ” are propelled to work even harder to fit into that mold.
And that mold can be a tight fit even by Asian beauty standards, in which women stereotypically are seen as being naturally “petite,” with porcelain skin and angular features. Grace, a second-generation Asian American, said she wasn’t as affected by American media as much as she was by images of Korean pop groups with 90-pound girls. “I would be thinking, ‘Wow, I’m 30 pounds overweight,’ when I was a healthy 120 pounds,” Grace recalls.
Stuck between cultures – and classification
While mainstream American media tends to gloss over the issue of body image in minority communities, so do mainstream research methods. “Most psychological research [to date] has been done on affluent white populations, usually college populations, and a lot of the research has only looked at the two major syndromes – anorexia or bulimia,” said Chang. “A lot of clinics won’t even look at you if you don’t meet the criteria.”
Although the common perception is that eating disorders only fall into two categories, the majority of people dealing with disordered eating actually fall into a third category called ED-NOS, or Eating Disorder-Not Otherwise Specified, according to the current Diagnostic and Statistical Manual of Mental Disorders. This category would include someone who binge eats without purging or starves herself without losing her period, i.e. someone who has all the symptoms of an eating disorder minus the extreme effects.
Grace may have begun purging the summer she was 19, but she had started exercising rigorously months before that, sometimes going to the gym up to three times a day, and keeping a strict watch on her calorie intake.
“I had always been self conscious about my body and had low self-esteem,” she said. “Rather than concentrate on consuming food like I’d done the first 19 years of my life, I concentrated on not consuming it, and when I felt like I had lost control, I concentrated on un-consuming it.” The step between not consuming and un-consuming is a small leap, but one that distinguishes between not having an eating disorder and actually qualifying for a diagnosis.
Grace said she knew she had to get help when she was “bingeing and purging four to five times a day.” What she didn’t know was that her behavior leading up to “full-blown” bulimia is also considered as disordered eating. As Dr. Mok asserted, “Part of the problem is that the [current] definition excludes culture, the preoccupation with food, weight, binge eating.”
And food is such an integral part of Asian and Asian American culture. Particularly in immigrant communities, food is culture, a way to connect with unique pasts and histories. Curry, kimchi, char siu bao – these words break down the umbrella term “Asian American” into its distinct roots using nothing more than lunch dishes.
“The significance of eating or not eating has complicated meaning,” said Chang. “Food is used as love. Take the image of the Asian mother saying, ‘Eat, eat, eat.’ Meal times are frequently the only times to connect [with family].” For someone with an eating disorder, the battle between control and culture can be as stressful as the disorder itself.
“We have to start asking what’s wrong here”
Grace, now 23, has been dealing with bulimia now for “four years and counting,” but had a hard time initially revealing her struggle to her strict Korean parents.
“For me, my identity as the eldest child of immigrants has everything to do with my eating disorder,” she said. “Bulimia is about control. I control the amount of food I consume. I control the amount of food I purge. I abused [my eating habits] to cope with feelings I couldn’t express because of cultural differences in my family.”
These differences often make it difficult to talk about sensitive topics like mental health, especially in cultures that see such issues as bringing shame to the family.
“[Being] a second generation Asian American brought about enormous amounts of pressure and an unfulfilled desire for independence,” Grace said. “I wanted to make my own life decisions, but [I somehow believed] that going against my parents was a slap in their faces, as if I was turning my back on the hardships they experienced. I internalized guilt through self-destruction.”
Grace finally told her parents about her bulimia – two years after her first purge – and eventually went to see a therapist. But she said the first step long before that was telling a friend, and she has since gotten a handle on her eating disorder by slowly tearing down the “wall of lies and deception that [she] had built up.”
“I stopped sneaking around for my next fix of food and throwing up,” she said. “I was open and honest. I wasn’t ashamed to speak about my self-esteem and my relationship with food.”
A psychologist can be a useful resource in preventing problems from erupting. Because Asian Americans under-utilize mental health resources available to them, researchers and health administrators may be led to believe that the community doesn’t need them at all, which is far from the case.
“Asian Americans tend to underreport mental health issues,” said Dr. Szu-Hui Lee, a clinical psychologist and director of training at the McLean Hospital at Harvard Medical School. “There’s a big stigma with seeing a psychologist. [Asian American] parents are more likely to send their kids to an academic counselor than a psychologist.”
“Asian American women have one of the highest suicide rates,” said Lee. “People really have to start scratching their heads and asking what’s wrong here.”
The key to prevention is talking about it. To those who still struggle in secret, Grace advised, “Talk to someone. It sounds easier than it is. Eating disorders make you secretive and distrustful of everyone. But choose one person that you can confide in, and at least hear someone else other than your brain that’s tearing you down enough to punish your body.”
* Names have been changed.