In the margins: Black, Asian and Minority Ethnic women’s narratives of recovering from an eating disorder

Eating disorders are associated with white Euro/American women and were initially thought of as a ‘culture bound’ condition; that is specific to a particular culture. However, research and clinical experience shows that Black, Asian and Minority Ethnic (BAME) women in the United Kingdom and globally, experience the distress of disordered eating. There remains a debate about transferring diagnostic categories across cultures and how similar or different the experience of eating disorders is for BAME women compared with white women from the United Kingdom. This inquiry is a small scale qualitative inquiry asking questions of race and culture, of idioms of distress and intercultural meaning making explored through narratives of nine racially diverse women recovering from an eating disorder, drawing on a dialogical approach to narrative analysis. Recovering narratives are explored both to bring forth untold appreciative stories where personal stories of recovering is under researched, and to make transparent that research addressing BAME women and eating disorders is limited and where studies are undertaken, they remain invisible in mainstream clinical texts or journal articles. Individual/cultural and collective stories are identified through the analytic process drawing on creative non fiction writing techniques, weaving both traditional and dialogical methods of narrative analysis. The dialogical method centres on ‘voice, embodiment and emotional volitional tone’ of the storytellers, every voice contains multiple voices. The researcher is ready and attuned to listen to the emotional volitional tone, an active, embodied talk that invites reflexivity of the researcher who embodies and emotionally engages with the material creatively, contributing to the co construction of dialogical stories. In foregrounding storytellers’ strengths, capabilities and talking back to the orthodoxy of biomedical narratives is a position or resistance. Dominant discourses of eating disorders marginalise BAME women, and represent a challenge to clinicians and services. The lack of attention to diversity is shown to impede access to timely assessment and treatment. The ethnocentric narrative is further emboldened because racially diverse families are concerned about seeking help where services are seen as constructed for white persons leading to concerns about confidentiality and fear of stigma. Key findings are summarised below: The first two findings concur with current, though marginalised knowledge; the remainder of the findings are unique to this inquiry. • Eating disorders occur amongst BAME women and cause distress • Help seeking remains problematic; when help is sought there are access to treatment issues • Clinicians require training to challenge assumptions regarding BAME women and eating disorders • Eating disorder experiences may appear similar to white females though clinicians should not presume the pathway to the condition is the same • Migration, racism, colonisation, slavery, trauma, loss, bereavement, famine, war, starvation, the role of food, gender roles, family understanding of mental ill health and social change need to be taken into account in assessment and treatment • BAME women are positive about their recovering from eating disorders • BAME women co exist in individualistic and collectivist cultures and this may assist in recovering • Culturally informed practice/training guides are produced to support clinicians in identification, assessment, treatment and training. In concluding, this inquiry interrogates the dialectic between mainstream and subjugated narratives, contesting assumptions that it is only white women who experience eating disorders and brings forth marginalised narratives that resist, stand up and talk back to dominant narratives. BAME women experience the distress of eating disorders often without adequate support in our communities. As clinicians we are positioned now to consider our ethical responsibilities towards this visible/invisible heterogeneous group.