"I'm not White, I have to be pretty and skinny": A qualitative exploration of body image and eating disorders among Asian American women

Birds of a feather flocking together on Instagram: How racially similar followers and followings on Instagram are linked to young women's body image

In light of recent studies demonstrating the detrimental effects of social media use on young women's body image, we examined the racial composition of young women's Instagram followers, as well as the racial composition of the individuals in young women's followed Instagram accounts, in relation to their appearance ideals and body image. Based on social identity theory (Tajfel & Turner, 1979), we tested two main propositions. First, women who have racially similar followers and followed accounts will be more likely to internalize body ideal preferences that are relevant to their in-group (i.e., thinness for Asian-American and White women; curviness for Black and Latina women). Second, following and being followed by people of one's racial identity in-group will have ameliorative effects on young women's body image (i.e., more body appreciation; less body dissatisfaction). Our sample included 533 U.S. women who identified as Asian-American (n = 97), Black (n = 101), Latina (n = 98), or White (n = 237). The results provided more support for the notion that racially similar followers and accounts followed are related to better body image outcomes rather than to the internalization of body ideals. Specifically, following a higher percentage of racially similar accounts was positively associated with body appreciation among Asian-American and White participants and negatively associated with body dissatisfaction among Asian-American participants. Likewise, being followed by a higher percentage of racially similar others was positively associated with body appreciation among Asian-American, Black, and White participants, and negatively associated with body dissatisfaction among Latina participants. The findings are discussed in light of social identity theory.

Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives

OBJECTIVE

A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals.

METHOD

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies.

RESULTS

A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking.

DISCUSSION

Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.

Exploring Sociocultural Influences Affecting Body Image in Survivors of Childhood Sexual Assault

This phenomenological study explored the lived experiences of survivors of childhood sexual assault, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. Utilizing a social constructivist framework, the research team interviewed eleven (n = 11) participants from a variety of backgrounds who were gender assigned female at birth and had survived childhood sexual assault (CSA). Four major themes emerged from the narratives collected. These include sociocultural impacts which included four subthemes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences; meaning making of the critical event, i.e., childhood sexual assault; self-perception of their bodies; internal processes that have shaped their perceptions and meaning making, i.e., thoughts, feelings, and behaviors. Findings indicate major influence of sociocultural factors in shaping participant's internal processes as survivors of CSA, meaning making, and subsequently self-perceptions of, and relationship with, their bodies. We discuss CSA and body image keeping the intersectionality of the individual, their experiences, and the impact of sociocultural contexts on that intersectionality.

Anorexia nervosa through the lens of primary health care practitioners in the Kyrgyz Republic

BACKGROUND

Anorexia nervosa was investigated in a large number of studies. Several of the studies in our review highlighted how important it is to factor in the opinion of health care practitioners if we want to improve the quality of the medical care provided to patients with anorexia nervosa. Additionally, the dominance of studies focused on anorexia nervosa within the Western culture raised the need for cultural diversity in such research.

AIM

The present study endeavored to explore how primary healthcare practitioners in Bishkek, Kyrgyz Republic, perceive anorexia nervosa and people who suffer from it.

METHODS

The study used the qualitative approach of Interpretative Phenomenological Analysis. Six semi-structured interviews with six primary health care practitioners from Bishkek were conducted.

RESULTS

The analysis of the collected data pointed towards four themes: (1) Anorexia nervosa as a reaction to distressing events in the form of loss of appetite; (2) Attributing blame for developing anorexia nervosa by a patient to family members; (3) Local versus Western socio-cultural standards in the development of anorexia nervosa and seeking treatment; and (4) Denial of mental health disorders by patients.

CONCLUSION

The discussion of the interpreted results led us to the conclusion that the perceptions of the health care providers in Bishkek represent the common prism through which anorexia nervosa is viewed in the larger population, which is constructed out of information received from the physical and virtual environments.

Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment

BACKGROUND

It has been well established that individuals who identify as lesbian, gay, bisexual, transgender, and queer are at increased risk for mental health pathology, including eating disorders/disordered eating behaviors (ED/DEB). However, less is understood about the unique experiences of transgender and gender diverse (TGD) people who struggle with ED/DEB.

AIMS

The purpose of this literature review is to examine the literature regarding the unique risk factors for TGD individuals who experience ED/DEB through a lens informed by the minority stress model. Additionally, guidance around the assessment and clinical management of eating disorders for TGD individuals will be presented.

RESULTS

TGD people are at increased risk for developing ED/DEB due to a number of factors including: gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care.

CONCLUSION

While guidance around assessment and treatment of ED/DEB for TGD individuals is still limited, adhering to a gender affirmative care model is essential.

Asian students in the anglosphere - unravelling the unique familial pressures contributing to eating pathology: a systematic review

BACKGROUND

There is no clear consensus on the specific familial pressures affecting Asian students in the Anglosphere, despite the validation of the Tripartite Influence model of eating disturbances in this group. However, traditional familial risk factors for disordered eating can be elevated for immigrant Asians with collectivistic-oriented familial dynamics, necessitating an examination of the culture-specific risk profile for eating pathology in student-aged Asians. This systematic review aims to consolidate and critically examine the literature on the most widely studied familial pressures related to disordered eating in Asian students in the Anglosphere.

METHODS

A systematic search was conducted in five databases for peer-reviewed articles measuring familial pressures and eating pathology in Asian students > 10 years old from an Anglosphere country. Following PRISMA guidelines, papers were screened by title, abstract and full text based on the eligibility criteria. Eligible studies were qualitatively analysed and synthesised narratively to assess the relationship between familial pressures and eating pathology.

RESULTS

In total, 14 papers were eligible for inclusion in the review. Eight topics related to familial stressors were identified (1) intergenerational conflict; (2) lack of familial cohesion; (3) parental overprotection; (4) low parental care; (5) familial achievement orientation; (6) parental expectations; (7) parental criticism; and (8) direct parental influence. In multiple studies, intergenerational conflict, maternal overprotection, and familial achievement orientation were significantly elevated and associated with disordered eating in US and UK Asian students, compared to white students. The studies examining parental criticism and familial cohesion had more heterogeneous findings.

CONCLUSION

The findings demonstrate the perception of Asian parenting styles as overprotective and incompatible with individualist-oriented Western values could increase eating pathology in adolescent and university students living in Anglosphere countries. The synthesised findings of the literature also indicate disordered eating acts as a compensatory mechanism for the ongoing psychological distress generated from intergenerational conflict and familial achievement orientation. Conversely, traditional eating disorder literature on familial cohesion and low parental care may not be applicable to young Asians. Future research should focus on how social appearance anxiety and psychological factors can mediate the link between disordered eating and familial stressors in Asian students.

Aboriginal and/or Torres Strait Islander women's body image: A qualitative study

Aboriginal and/or Torres Strait Islander peoples refer to the traditional owners of Australia and have the oldest continuing culture in the world. Body image has scarcely been investigated among adult Aboriginal and/or Torres Strait Islander (Indigenous) women, despite evidence that racism and colourism broadly contribute to adverse psychological outcomes for this population. Therefore, we conducted a qualitative study investigating Indigenous womens' body image with specific focus on racism, colourism, and cultural identity. Sixteen Indigenous women completed individual interviews or took part in group yarns - a culturally sanctioned method of information sharing. A reflexive thematic analysis generated three themes: (i) Dominant beauty ideals in Australia exclude Indigenous women and are informed by colonisation and stereotypes of what Indigenous women "should" look like, (ii) Variations in Indigenous women's identities and appearances influences the types of discrimination that they receive and impacts their sense of belonging, and (iii) A change journey occurs over time towards body acceptance which is informed by changes in understandings of body image and cultural identity. Broadly, participants described racism and colourism as negatively impacting their body image. Importantly, developing a strong cultural identity mitigated these impacts by facilitating both a sense of belonging and body acceptance - highlighting a potential protective factor.

Medical mistrust among women with intersecting marginalized identities: a scoping review

The purpose of this scoping review is to synthesize knowledge about medical mistrust and health among women who occupy other marginalized identities; namely women who also belong to one or more of the following social groups: people of color, people of low socioeconomic status, people with disabilities, lesbian and bisexual women, and/or women who have sex with women. This scoping review is based on the methodological framework by Arksey and O'Malley (2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8: 19-32. doi:10.1080/1364557032000119616). Specific search terms were entered into selected databases. Based on a set of inclusion criteria, articles were screened and assessed for eligibility. Data from the selected articles were extracted and summarized. Forty studies were included. Thirty-one studies used quantitative methodology, of which more than half used the Group-Based Medical Mistrust Scale. The majority of studies (84%) investigated the intersection of gender with race and ethnicity. Breast cancer and HIV combined accounted for more than half of the included studies. Of those studies that examined the relationship between medical mistrust and a health outcome or health behavior, almost all reported that medical mistrust had a deleterious impact. Medical mistrust among women with intersecting marginalized identities is worthy of further study, and there is still a dearth of knowledge in the role of medical mistrust among a wide range of subgroups of women and health domains.

Demographic and sociocultural predictors of sexuality-related body image and sexual frequency: The U.S. Body Project I

Body image is a critical component of an individual's sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one's body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.

Racial identity differences in pathways from sociocultural and objectification constructs to body satisfaction: The U.S. Body Project I

Racial minority men and women face a wide variety of appearance-related pressures, including ones connected to their cultural backgrounds and phenotypic features associated with their identity. These body image concerns exist within a larger context, wherein racial minorities face pressures from multiple cultures or subcultures simultaneously to achieve unrealistic appearance ideals. However, limited research has investigated racial differences in the relationships between theorized sociocultural risk factors and body image in large samples. This study tests pathways from an integrated sociocultural model drawing on objectification theory and the tripartite influence model to three key body image outcomes: appearance evaluation, body image quality of life, and face image satisfaction. These pathways were tested using multigroup structural equation modeling in a national sample of White, Black, Hispanic, and Asian men and women (ns = 205-4797 per group). Although many hypothesized associations were similar in strength across groups, race moderated some of the pathways between sociocultural pressures (media, peer, family), internalization of appearance ideals (thin-ideal, muscular/athletic), appearance surveillance, and body image outcomes. Findings support the likely role of both shared and specific risk factors for body image outcomes, suggesting avenues for tailoring adapted interventions in order to target culturally-salient risk factors.

Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9–4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2–1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6–2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1–1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review

BACKGROUND

Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier.

METHODS

Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18-25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review.

RESULTS

Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns.

CONCLUSIONS

The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone-like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.

"I'm not a teenager, I'm 22. Why can't I snap out of it?": a qualitative exploration of seeking help for a first-episode eating disorder during emerging adulthood

BACKGROUND

Eating disorders (EDs) typically have their onset during adolescence or the transition to adulthood. Emerging adulthood (~ 18-25 years) is a developmental phase which conceptually overlaps with adolescence but also has unique characteristics (e.g. increased independence). Emerging adults tend to come to ED services later in illness than adolescents, and emerging adulthood's unique characteristics may contribute to such delays.

OBJECTIVE

This study aimed to explore attitudes towards ED symptoms, and their implications for help-seeking, amongst emerging adults receiving ED treatment through FREED, an early intervention care pathway.

METHOD

Participants were 14 emerging adults (mean age 20.9 years; SD = 2.0), all currently receiving specialist treatment for a first-episode, recent-onset (< 3 years) ED. Semi-structured interviews relating to experiences of help-seeking were conducted, and data were analysed thematically.

RESULTS

Symptom egosyntonicity, gradual reappraisal and feelings of exclusion from ED discourse were key attitudinal phases prior to help-seeking, each of which had distinct implications for help-seeking.

CONCLUSIONS

Emerging adults with first-episode EDs show a distinct set of help-seeking-related challenges and opportunities (e.g. help-seeking for others; help-seeking at transitions; self-sufficiency). This research might be used to inform the development and evaluation of interventions which aim to facilitate help-seeking amongst emerging adults with first-episode recent-onset EDs.

What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology

OBJECTIVES

The aim of this study was to investigate help-seeking attitudes, intentions, and behaviors, and to systematically explore perceived barriers to help-seeking for eating, weight, or shape concerns among young adults. Differences in perceived barriers as a function of type of eating disorder symptomatology were also examined.

METHOD

Data were collected using an online survey among individuals (aged 18-25 years) in Australia. Overall, 291 young adults with varying levels of eating disorder symptoms completed measures of disordered eating, weight or shape concerns, help-seeking barriers, attitudes, intentions, and behaviors. According to their self-reported symptoms, participants were classified into four subgroups (i.e., anorexia nervosa [AN] symptoms, bulimia nervosa [BN] symptoms, binge-eating disorder [BED] symptoms, and other eating disorder symptoms).

RESULTS

Despite the belief that help-seeking is useful, only a minority of participants with elevated symptoms, namely those with AN, BN, and BED symptoms, believed they needed help. Across the sample, the most frequently cited barriers to seeking help for eating disorder symptoms were: concern for others, self-sufficiency, fear of losing control, denial and failure to perceive the severity of the illness, and stigma and shame.

DISCUSSION

The findings highlight the need to educate young adults about the severity of eating disorders and the importance of seeking help, and to increase the awareness of help-seeking barriers among those designing public health interventions as well as clinicians. Our findings suggest that help-seeking barriers may differ depending on the type of eating disorder symptomology.

From the jungle to urban centers: body image and self-esteem of women in three different cultures

The aim of this study is to compare body image, body perception, body satisfaction, body-related self-esteem and overall self-esteem of women from three different cultural backgrounds. The survey covers a sample of 187 women, including 133 Germans, 31 Q’eqchi’, and 23 Colombians. Two groups (in Germany and Colombia) live in urban centers, while one group (in Guatemala: Q’eqchi’) is a jungle-based ethnic group descended from the Maya where the body perception was largely unaffected by media. The instruments used in this study are the Figure Rating Scale, the Body-Esteem Scale and the Rosenberg Self-Esteem Scale. According to the study, German and Colombian women prefer a significantly slimmer body and perceive themselves more critically than Q’eqchi’. There are no significant differences in body perception between German and Colombian women. Q’eqchi’ women do not have significantly higher body satisfaction than German and Colombian women. Although German women have significantly higher body satisfaction than Colombian women, Q’eqchi’ women have the highest body-related self-esteem on average. Colombian women in turn have a higher body-related self-esteem than German women. There is a positive correlation between body satisfaction with both body-related self-esteem and overall self-esteem in all three groups. In conclusion, the German and Columbian women living in urban settings look much slimmer, prefer much slimmer bodies and have lower body-related self-esteem, compared to jungle-dwelling Q’eqchi’ women in Guatemala.

Eating Disorders During Emerging Adulthood: A Systematic Scoping Review

Background: Eating disorders (EDs) during the transition to adulthood can derail social, psychological, and vocational development. Effective treatment is of paramount importance, yet young adults' treatment needs are typically less well met than those of adolescents. In recent years, there has been a considerable shift in how developmental psychologists understand the transition to adulthood, with this life-phase reconceptualized as “emerging adulthood” (EA) (~18–25 years). Engagement with burgeoning developmental research is likely key to providing more effective care for young people experiencing EDs.

Aims: To review ED research which has utilized the concept of EA, and to assess the usefulness of this concept for ED research and practice.

Methods: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Three databases (Psychinfo, PubMed, Embase) were searched for papers which explicitly focused on EDs during EA. No restrictions as to publication type, language, study design, or participants were applied. Included studies were assessed for developmental “informedness,” and findings were qualitatively synthesized.

Results: Thirty-six studies (N = 25,475) were included in the review. Most studies used quantitative methodologies, were cross-sectional in design and focused on identifying psychological and social factors which contribute to etiology of EDs. Many studies (N = 22) used well-defined samples of emerging adults (EAs); few studies (N = 8) included developmental measures relevant to EAs. Findings indicate that whilst factors implicated in EDs in adolescence and adulthood are relevant to EAs, EA-specific factors (e.g., identity exploration) may also contribute. Conventional ED services and treatments present difficulties for EAs, whilst those adapted to EAs' needs are feasible, acceptable, and more effective than treatment-as-usual. Directions for future research and clinical implications are discussed.

Conclusion: Existing research indicates that the EA concept is relevant for understanding EDs during the transition to adulthood, and ED services should implement adaptations which exploit the opportunities and overcome the challenges of this developmental stage. EA is currently an underused concept in ED research, and future engagement with the developmental literature by both researchers and clinicians may be key to understanding and treating EDs during transition to adulthood.