Eating disorders are dangerous mental and physical health concerns that will affect 9% of Americans at some point within their lifetime, equivalent to 28.8 million individuals (Deloitte Access Economics, 2020). Eating disorders affect multiple components of an individual’s life, including self-esteem. Biological, psychological, and sociocultural factors can influence the development of eating disorders (National Eating Disorders Association [NEDA], n.d.).
Like many illnesses, eating disorders can be challenging to treat and cause various long-term health consequences for the individual. Anorexia Nervosa (AN) causes 10,200 deaths each year (Deloitte Access Economics, 2020) and has the highest mortality rate of all psychiatric diseases (Edakubo & Fushimi, 2020). Males are twice as likely to die from anorexia nervosa compared to females and may be due to lack of social support during treatment and waiting longer to obtain treatment (Deloitte Access Economics, 2020). Check out our social media pages (Facebook, Instagram, and Twitter) to learn more about eating disorders in males.
Elements that can impact an individual’s probability of an eating disorder include race, age, gender, sexual orientation, health, and life events. Racial differences also affect the likelihood of obtaining treatment for eating disorders. Black, Indigenous, and People of Color (BIPOC) are half as likely to receive treatment for eating disorders or be diagnosed (Deloitte Access Economics, 2020).
The disparity in care exhibits how some communities encounter barriers when attempting to receive medical care compared to other groups. A study by Uri et al. (2021) found that Asian American college students reported higher levels of body dissatisfaction and more negative perceptions of obesity than their White and Black, Indigenous, and People of Color (BIPOC) peers. The study also observed that Asian American college students demonstrated an increased probability of restricting food consumption or purging.
The highest prevalence of eating disorders is in individuals between 20-29 years old, with females having a higher prevalence than males across all age groups (Deloitte Access Economics, 2020). Although young adults exhibit the highest prevalence of eating disorders, adolescents also report a higher prevalence than middle-aged and older adults. A recent study observed that over two-thirds of adolescents receiving treatment for an eating disorder experienced a trauma (Groth et al., 2020). The increased prevalence among adolescents and young adults implies that individuals within this age range are at an increased risk.
Research examining the role sexual orientation plays on body image observed that heterosexual females were more affected by society’s beauty standards than homosexual and bisexual women and placed a higher prominence on striving for thinness (Henn et al., 2019). Trans college students were four times more likely to engage in disordered eating than their cisgender classmates. The increased disordered eating habits may be partially due to gender dysphoria and body dissatisfaction (Muhlheim, 2021). Various components of our lives, such as life experiences and health challenges, play a significant role in the development and course of eating disorders.
Research has observed a relationship between trauma and eating disorders (Gomez et al., 2021; Groth et al., 2020), which can generate additional complications when implementing a successful treatment plan. Therefore, medical professionals must consider additional factors such as life experiences or other health challenges when selecting a treatment plan for patients. Experiencing trauma increases the probability of an eating disorder, affects coping strategies, experience additional trauma-associated symptoms, exasperate eating disorder symptoms, and has been associated with decreased effectiveness regarding treatment (Arabaci et al., 2021; Brewerton, 2019; Gomez et al., 2021; Groth et al., 2020; Rienecke et al., 2020; Scharff et al., 2021; Scharff et al., 2021; Serra et al., 2020; Trim, 2021). These factors can produce additional struggles for the individual during their recovery and may benefit more from a different treatment approach than individuals that have not experienced trauma. Research suggests that individuals that have experienced trauma would benefit most from a trauma-centered treatment approach addressing both eating disorder symptomology and helping the individual heal from the trauma (Rienecke et al.,2020).
Experiencing trauma has been associated with numerous mental health struggles, including obsessive-compulsive disorder (OCD), anxiety, depression, posttraumatic stress disorder (PTSD), and body dysmorphic disorder (BDD), which can exacerbate eating disorder symptoms. A trauma-focused approach also has the potential to concentrate on reducing body dysmorphic disorder (BDD) symptoms that are two times as likely in patients with posttraumatic stress disorder (PTSD) (Valderrama et al., 2020).
Recovery is a challenging and often non-linear process that often includes setbacks, additional challenges, and frustration. Developing a positive body image can be difficult due to the messages we receive from the media concerning what the “ideal body” looks like and culture. Some ideas that can help improve body image include focusing on all the things our bodies are capable of, reminding ourselves that our worth isn’t dependent or influenced by our body, speaking kindly to ourselves, and surrounding ourselves with others that are body positive. Some individuals suggest posting positive affirmations in locations where you will see them throughout the day to remind yourself how wonderful and talented your body is. It’s also important to remember that it’s never too late to ask for help or seek treatment. There isn’t just one appropriate treatment plan for eating disorders, and recovery is often a lifetime process. Some individuals find support groups to be beneficial, or cognitive-behavioral therapy. National Eating Disorders Association (NEDA) provides a list of in-person and virtual support groups offered in the United States, screening tools for eating disorders, support via online chat, phone, or text message, or match you with a recovery mentor, for more information. For more information regarding the services and resources NEDA offers, please visit their website at https://www.nationaleatingdisorders.org/.
In 1976, Black History Month was officially recognized by President Gerald Ford with the goals of honoring the African diaspora and raising awareness for African-American history. The history of Black History Month dates back to 1915 when historian Carter G. Woodsen founded an organization that is known today as the Association for the Study of African American Life and History (ASALH). This organization was dedicated to researching and promoting the achievements of Black Americans and other African descent. In 1926, this organization sponsored a national “Negro History Week” that then evolved into Black History Month in the late 1960s partially due to the civil rights movement and a growing awareness of the Black identity (History.com, 2022).
This year’s theme of “Black Health and Wellness” highlights the legacy of Black scholars and medical practitioners in Western medicine. It also brings awareness to initiatives to help decrease economic disparities and discrimination in medical institutions. These initiatives aim to include having more diverse practitioners and representation in all health sectors.
This theme is especially important this year because with COVID-19, the mental health of many African American families has been impacted. Within the community, there are higher levels of stress, anxiety, and depression due to racial health disparities. Ibrahimi and others (2020) found that Black Americans are more susceptible to contracting COVID-19 due to factors of systemic racism. At the community level, they lack access to equitable healthcare and healthy food options. At the public policy level, Black Americans are disadvantaged by segregated housing and lack of access to equal education and job opportunities. Compared to others, they are more likely to live in densely populated areas, increasing their potential contact. In addition, Black Americans make up the majority of the essential workforce, including 30% of bus drivers, and 20% of food service workers. These structural conditions exacerbate the impact of COVID-19 on mental health as a consequence of stress, fear, and anxiety, which in severe cases result in PTSD and/or depression (Ibrahimi et al., 2020).
The pandemic isn’t the only traumatic event that’s created a ripple of psychological effects. From history, there are many causes for intergenerational trauma in Black American families. This refers to a type of trauma that affects future generations, regardless of whether they were exposed to the event or not. Families with a history of unresolved trauma, depression, anxiety, and addiction may continue to pass on unstable coping strategies and patterns to their families. Slavery, Jim Crow laws, police brutality, and systemic racism and discrimination have caused effects such as PTSD, anxiety, depression, substance abuse, poverty, and fearfulness in the Black community (Bendib & Benia, 2020). Generations who didn’t experience these events firsthand can still feel the effects of them from their families and society. As long as systemic racism is prevalent, the cycle of intergenerational trauma in Black American families does not end.
According to McLeod and others (2020), Black Americans comprise 13% of the US population, yet data suggests that they represent 23% of those fatally shot by police officers. Data on non-lethal encounters with police in the Black community is less available, but can understandably result in emotional trauma, stress responses, and depressive symptoms. The researchers conducted a study to assess if police interactions are associated with mental health outcomes among Black Americans. They found statistically significant associations between police interactions and mental health (psychotic experiences, psychological distress, depression, PTSD, anxiety, suicidal ideation and attempts), indicating a nearly twofold higher prevalence of poor mental health among those reporting a prior police interaction compared to those with no interaction. Changes in law enforcement policy, improved community outreach, mandated reviews of policy and practice in police departments, and expanded police training initiatives could reduce the potential negative mental health impact of police interactions on Black Americans (McLeod et al., 2020).
Black History Month was established to both honor the achievements and teach the history of Black Americans. It’s important to learn about accurate American history and how these events impacted the mental health of many generations. Unfortunately, events involving racism and prejudice are still happening today. But, moments like Black History Month give us an opportunity to teach and learn about Black history.
For this year’s Black History Month, wide-ranging events include panel discussions on health care disparities, health screenings, lectures on Black pioneers, art shows, children's storytime hours, and yoga and meditation sessions. Additionally, ASALH will host a virtual festival, which includes a moderated conversation on February 19th with the leaders of Black medical schools and professional organizations. Be sure to check these out to learn more about Black history and excellence!
Experiencing trauma can prompt some individuals to develop post-traumatic stress disorder (PTSD) and cause a negative long-term effect on an individual’s health and functioning. Some individuals may experience post-traumatic stress symptoms without meeting the diagnostic criteria of post-traumatic stress disorder. PTSD is a stress-related condition that may occur when an individual experiences serious injury, violence, trauma, or perceived threat (American Psychiatric Association [APA], 2013). These individuals may experience increased physiological arousal, re-experience the situation, avoid places or concepts that remind them of it, or negative thoughts or feelings, such as anger, sadness, or guilt (APA, 2013). Experiencing trauma can also adversely affect the individual's sleep, relationships, ability to function, cause distress, and contribute to other physical and psychological symptoms.
While previous research observed that many individuals experiencing chronic pain also suffered from depression or anxiety (Banks & Kerns, 1996, as cited in Linnemørken et al., 2020), recent studies began investigating a potential relationship between chronic pain and PTSD. Chronic pain refers to pain occurring most days of the week for over three months (National Center for Health Statistics [NCHS], 2020). Individuals who experience both chronic pain and PTSD also reported more extreme pain symptoms, difficulties sleeping, distress, increased disability, and fatigue compared to individuals with chronic pain but without PTSD (Akhtar et al., 2019; Linnemørken et al., 2020).
Encountering chronic pain can cause additional challenges in managing their post-traumatic stress symptoms; Accomplishing tasks such as attending appointments, picking up medications, or getting out of bed may be more challenging. Chronic pain can negatively affect their ability to function and care for themselves as well as cause distress. Medical professionals need to consider the possibility of clients presenting with PTSD to avoid misinterpreting these behaviors to depression, or avoidance. Selecting a treatment plan that targets both the patient's chronic pain and PTSD symptoms is essential to improve their quality of life as many of these symptoms can negatively impact the client's capability to adhere to treatment.
Research with patients receiving treatment for chronic pain at an outpatient pain clinic observed that 20.7% met the diagnostic criteria for PTSD (Linnemørken et al., 2020). However, other research suggests that the percentage of individuals with PTSD and chronic pain may be higher, as it varies across settings and populations (Akhtar et al., 2019).
Research is still investigating what approach would most effectively target both PTSD symptoms and chronic pain; Some research suggests that a multidisciplinary approach utilizing cognitive behavioral therapy (CBT) techniques may be helpful (Cosio & Demyan, 2021; Kind & Otis, 2019). Cognitive behavioral therapy focuses on replacing negative thoughts, feelings, or behavioral patterns with more productive ones (Kind & Otis, 2019).
Many individuals with PTSD and chronic pain comorbidity are more likely to experience pain catastrophizing than individuals who only experience chronic pain (Linnemørken et al., 2020). Pain catastrophizing affects the individual's coping abilities as the individual tends to experience helplessness, assume the worst possible outcome, and prompt distress. Employing a treatment approach that replaces negative thought patterns, such as pain catastrophizing, may have the ability to decrease the patient's distress response to pain and reduce anxiety.