Understanding Bulimia: A Qualitative Exploration of the Roles of Race, Culture, and Family

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The eating disorder, bulimia nervosa, is a serious physical and mental illness destroying the lives of millions of men, women, and their families. It is characterized by recurrent binge eating and compensatory behaviors (e.g., self-induced vomiting), and afflicts 1-5% of the general U.S. population. Unlike other eating disorders that appear to affect specific racial groups, bulimia more equally affects people of all races. Yet, very little attention has been given to learning about the ways in which women from diverse racial/cultural backgrounds experience bulimia. Thus, the present qualitative study explored the question: How do young African American, Latina, and Caucasian women describe their experiences with bulimia within their racial, cultural, and familial contexts? Open-ended, in-person interviews were conducted with 33 young adult women (ages 18-30) who self-identified as African American, Latina, or Caucasian and who experienced bulimia while living with a parent. Questions were based on sensitizing concepts taken from feminist and family systems theories, and encouraged women to explore their perceptions of how their racial, cultural, and familial contexts influenced their experiences with bulimia. A modified grounded theory approach was used to interpret the data, and findings were organized at sociocultural, familial, and individual levels. Common experiences for many of the women, regardless of race, included sociocultural pressure to be thin; unhealthy family environments that included poor communication, strained relationships, and emphasis on members' appearances; and individual management of comorbid psychological disorders and emotions. Unique processes related to African American women's and Latinas' experiences with bulimia included living in a bicultural context with cultural and familial stigmas surrounding mental health. Additionally, African American women reported overall healthier family environments, in which they had supportive relationships and more open communication. Based on these findings, the theoretical framework was enhanced with race- and culture-specific models. Implications for research related to diverse families' experiences with eating disorders, policies designed to help people of all backgrounds affected by eating disorders, as well as the development of culturally sensitive therapy interventions for families affected by bulimia are discussed.