Young Asian American women tend to have cultural and family influences that discourage them from seeking help for eating disorders, according to new research led by Yuying Tsong, Cal State Fullerton associate professor in human services.
Compared with a general population with eating disorders, young Asian American women displayed some common themes, the study found, including:
- Lack of knowledge of eating disorders, which extended to their parents
- Lack of knowledge of treatment available or how to seek treatment
The study is one of few in eating disorder literature to examine Asian Americans in particular, Tsong said; most focus on white Americans. But what research there is indicates that while Asian Americans are at equal risk for eating disorders, they are often misdiagnosed or under-diagnosed. “So there is a stereotype that Asian American women don’t have as many eating disorders as white women do,” Tsong said.
Compounding matters is the fact that Asian Americans are half as likely as white Americans to seek mental health services in general, a 2016 review of studies on the subject showed.
The latest research builds on a study published in 2011 by the two women, who led a team that collected observations from 12 therapists with expertise in eating disorders. The therapists viewed Asian American clients as being under considerably more pressure to be thin and to achieve, compared with clients across all cultures. Parents strongly encouraged thinness, perhaps influenced by the belief that it was key to their daughters’ success in the United States. Most of these clients were first- and second-generation and still in the stressful process of acculturation. The messages they were receiving, according to the 2011 study, were to adapt to the U.S. mainstream through professional success; conform to Asian gender standards; not embarrass family by being other than very thin; and attract the best possible mate. At the same time, the young women were required by respect for their elders to not reject food offered to them.
Eating disorders offered the young women a way to cope with this stress by emotionally disconnecting or expressing distress covertly. Many of the therapists surveyed, most of whom are also Asian American, said treatment included helping parents understand notions of individuation, privacy and boundaries, and explain that while these are Western concepts, they exist in Asia too.
The 2011 study cites 2001 research on ethnic minority women that sounds like a psychological Catch-22: The more acculturated to Western culture they were, the greater the likelihood of eating disorders; and the less acculturated, the more cultural conflict and stress, and the greater the likelihood of eating disorders.
But there was little research done on the barriers that Asian American women experience when they seek help for eating disorders, what keeps them engaged in treatment and reasons for stopping treatment early.
So Tsong and Smart, along with three students in the Department of Counseling, recruited Asian Americans who had experienced disordered eating behaviors or body image concerns. The final sample totaled 212 participants with an average age of just under 25, including students at Cal State Fullerton. About three quarters were female, and a little more than half were second-generation. The team categorized barriers preventing the students from seeking mental health services into personal, social, structural, stigma, beliefs and mental health literacy.
Read more about the study and its findings on The Orange Country Register website.