As a researcher, a Black woman of dual heritage, and someone with lived experience of anorexia nervosa, I know first-hand how devastating this condition can be. My enduring memory is of its crippling loneliness; anorexia is not just an assault on our physical health but on our very being and our need for closeness, tenderness, and sexual desires. Infamously coined as the psychiatric condition with the highest mortality rate, anorexia isolates us not just from our loved ones, but also from the wider community, so that we dwell in our own ever-diminishing world.
There is a misconception that Black women are immune from developing a ‘white girl’ disorder like anorexia. There is an assumption that ‘Black’ culture’s alleged embrace of voluptuous, more attainable body types, theoretically reduces the pressure on Black women to strive toward thinness. Not true! Such a misunderstanding is based on the idea that eating disorders like anorexia are only about weight and physical appearance. In the context of structural racism and the acculturative stress of prejudice, disadvantage and the shrinking opportunities that it brings, eating disorders in Black women may be less about starvation of the body and more about hunger in the mind and a need for genuine connection.
As part of my doctoral research, I wanted to explore the intersection between anorexia, intimate relationships, and race. I conducted semi-structured interviews with nine British Black women who were willing to talk about their experiences of their romantic relationships in the context of their anorexia. Several themes emerged.
First came the not-unexpected problem of low self-esteem – all the women in this study described experiencing strong feelings of self-blame; they shared how their self-condemnation even took them to the point of subservience and a tolerance of abuse in their relationships. One participant lamented: “In my last relationship, I didn’t feel worthy and by extension, I allowed some pretty shit behaviour”.
Even if not experiencing abuse in an objective sense, their unshakable low self-esteem meant that they were vulnerable to subjugating their own needs to please others in their relationships which may, of course, be linked to the gender stereotype that women should be self-denying and achieve emotional fulfilment through the nurturing of others. The women described how different they felt. It is perhaps unsurprising then that most participants described lacking libido, focusing solely on the function of sex – to satisfy their partners’ needs – rather than enjoying it for themselves.
Most of the women described feeling that the racism they faced was at the heart of their profound feelings of inferiority, undesirability, and lack of belonging. One woman of dual heritage shared how she feels “too White for Black people and too Black for White people”, highlighting how she developed her eating disorder in an attempt to “fit into the Eurocentric ideal”. Another participant emphasised the pressure that Black women experience to “lose their curviness” so that they can conform to the White definition of beauty. Rooted in gendered racism, she described not wanting to be bigger than her partner due to what she believed this would represent – that she is “dominant”, “loud” and “unmanageable” – and so perhaps feeding the innately intersectional ‘Sapphire’ stereotype which depicts Black women as large, domineering, aggressive, controlling, and angry (Watson et al., 2019).
Simply seeking intimacy as a way of attenuating their feelings of disconnection was no simple feat for the women. They described experiencing great ambivalence about being in a relationship – being both desperate for, and fearful of, connection. In fact, some highlighted how their anorexia served a protective function – it stopped them from getting ‘too close’ to others – and always took precedence over their romantic relationships. Their anorexia almost seemed to become a ‘third partner’ in their intimate relationships – ‘there were three people in this marriage’.
The participants also revealed their difficulties with navigating boundaries. Several women seemed to struggle with finding the right balance between connection and separateness in their relationships, with the majority recognising that they were particularly vulnerable to becoming dependent on their partners. But it was not all gloom. Whilst most participants described making a conscious effort to resist what could be seen as clinginess, they could also see the benefits of ‘letting someone in’. The women recalled how sometimes they had been supported both emotionally and practically by their partners and how their partners had made an active effort to engage in the process of their recovery from anorexia.
Interestingly, the relationship dynamic was not just about the participants’ own vulnerability. It could be a two-way street. Adding another layer of complexity, some women suggested that it was not they, but their partners, who showed signs of dependency in their relationships. This is a helpful reminder that difficult relational dynamics in couples in which one member has an eating disorder are unlikely to stem solely from the sufferer.
What was encouraging was the women’s resilience and optimism for positive relationships in the future, with one woman sharing: “Anorexia is not a permanent thing…My hopes and dreams are to have a family someday…I’m looking to a future. I won’t allow my kids to ever struggle with anorexia”. A few of the women held a balanced – if more cautious – perspective on romantic relationships, with one woman highlighting how “a romantic relationship involves someone who loves you regardless, is willing to walk with you, willing to compromise and sacrifice…someone who sticks by you…it doesn’t come in 10 years, it doesn’t even come in 20 years but a step at a time and you’ll definitely get there”.
There is a message here for therapists. The fact that many of the Black women in this study reported experiencing an imbalance of power within their intimate relationships emphasises the importance of professionals being sensitive to any such similar power imbalances that may arise within the therapeutic relationship too, and their incorporating cultural competencies, sensitivity, and humility into their clinical work.
The lessons from this research may help enable healthcare professionals to tailor interventions that are more attuned to the barriers facing all clients with anorexia, but especially Black women – a group already at risk of social disadvantage and marginalisation – and such knowledge can be used to develop individualised and holistic case formulations for clients.
What came out loud and clear in this study was that Black women struggle with anorexia too. The precipitating factors may differ, with gendered racism having a particularly pernicious role to play, but the wounds are the same: low self-esteem, loneliness and suppression of one’s needs.
The vulnerabilities lie not just in the individual, but we must recognise the impact of the wider system: their partner’s interactional styles and more broadly, structural racism. At a micro level, for example, romantic partners could potentially be involved in the therapy process; and at a more macro level, Eurocentric assumptions within the healthcare system should be continually challenged.