Multiracial individualsthose who identify with at least two racial categories–are one of the fastest-growing racial groups (Vespa et al., 2018). This population faces unique stressors that contribute to mental illness. For instance, a racial stressor called phenotype invalidation (the denial of an individual’s racial identity based on their appearance not being racially prototypical) is a prominent experience many multiracial people face (Franco & O’Brien, 2017). This is associated with higher levels of depression (Franco et al., 2021).
The experience of phenotype invalidation could potentially lead to an over-evaluation of one’s appearance, which is a core driver in eating disorder pathology. Various other factors could also increase eating disorder risk among multiracial individuals, for example, the western appearance ideal, which includes fair skin and Eurocentric features (Jankowski et al., 2017). This may encourage body dissatisfaction among multiracial individuals who do not exhibit physical similarity to this beauty standard. Body dissatisfaction is a well-documented risk factor for eating disorders (Stice & Shaw, 2002).
However, there is a lack of research investigating eating disorder prevalence rates among multiracial people. A recent study by Natasha Burke and colleagues (2021) aimed to overcome this research gap by examining prevalence estimates of eating disorders across several multiracial groups.
Multiracial individuals experience various stressors that may lead to an over-evaluation of their physical appearance and body dissatisfaction, both of which are core drivers in eating disorder pathology.
Methods
133,946 monoracial and 11,433 multiracial individuals participated in the study, with 56.8% identifying as male, 40.7% identifying as female and 2.4% identifying as a gender minority (i.e., transgender men, transgender women, genderqueer/gender non-conforming and other gender identities). American undergraduate and graduate students aged over 18 years were contacted to participate in a web-based survey about mental health. Data was collected from 199 US universities; in large universities, 4,000 students were randomly sampled, whereas all were asked to participate in smaller universities.
Participants reported their racial identity by selecting one or more ethnicity/racial categories. Furthermore, participants indicated their gender identity by selecting one of the following options: cisgender man, cisgender woman, and gender minorities. Lastly, the assessment of eating disorder pathology was done via the SCOFF questionnaire (Morgan et al., 1999), an eating disorder screening tool.
Statistical analyses involved comparing eating disorder prevalence rates among monoracial and multiracial individuals. Analyses were conducted in the full sample and stratified by gender identity.
Results
Multiracial groups identifying with the following racial categories: (i) Black and White, (ii) American Indian and White, (iii) Black and Latinx, (iv) Black and Asian and (v) American Indian and Latinx, had greater prevalence rates of eating disorder pathology compared to each monoracial identity. For example, those identifying as Black/White had a higher eating disorder prevalence (24.4%) compared to White (22.6%) and Black (18.4%) individuals.
However, the opposite pattern was observed for individuals identifying with the following multiracial categories: (i) Asian and White, (ii) Arab and White and (iii) Asian and Latinx, whereby they had a lower eating disorder prevalence than each monoracial identity. For example, Asian/White individuals had a lower eating disorder prevalence (22.2%) compared to White (22.6%) and Asian (28.2%) individuals.
Some multiracial groups demonstrate a higher eating disorder prevalence than each monoracial identity, for example, Black/White individuals. Other multiracial groups, such as Asian/White people, showed a lower eating disorder prevalence than each monoracial identity.
Conclusions
Overall, the findings demonstrate apparent differences between unique multiracial identities regarding eating disorder prevalence. This shows the importance of distinguishing between unique multiracial identities when researching mental health.
Mental health research should distinguish between unique multiracial identities as some identities appear to pose as risk factors, whereas others seem to be protective.
Strengths and limitations
This study has several strengths, such as that it had a large sample size that comprised various multiracial groups. This is uncommon in research about multiracial individuals’ mental health as this literature typically only has participants who are part-White. Furthermore, this is the first study to investigate the prevalence rates of eating disorders among multiracial individuals, which is essential in providing adequate mental health care to this population.
Having a sample of undergraduate and graduate multiracial students is a strength and limitation of the study. The multiracial population is younger on average than monoracial communities due to various reasons, most notably because interracial marriage only became legal in the United States 54 years ago. Therefore, recruiting from universities is an effective method to find a larger proportion of multiracial people willing to participate in this research topic. However, this limits the generalisability of the findings as the results may not apply to multiracial people who did not go to university, those in older generations and individuals outside of the United States.
This study was a commendable attempt at identifying prevalence rates of eating disorders among multiracial individuals, but only consisted of American students limiting the generalisability of the findings obtained.
Implications for practice
Considering the findings highlight increased rates of eating disorders among some multiracial groups compared to each monoracial identity, there is a need to ensure adequate and appropriate eating disorder treatment for these communities. One way is by practitioners ensuring they provide culturally sensitive treatment. A recent systematic review recommended various ways clinicians can be culturally considerate during eating disorder treatment, such as exploring ethnic identity and how this may serve as a protective or risk factor (Acle et al., 2021). Relatedly, focus should be placed on understanding why certain multiracial groups are more likely to develop an eating disorder than other multiracial groups. Understanding this could help inform culturally adapted prevention and treatment, further improving mental health care for this community.
We need to understand the underlying mechanisms as to why there are differences in eating disorder prevalence among unique multiracial groups.
Statement of interests
No conflict of interest.
Links
Primary paper
Burke, N. L., Hazzard, V. M., Karvay, Y. G., Schaefer, L. M., Lipson, S. K., & Rodgers, R. F. (2021). Eating disorder prevalence among multiracial US undergraduate and graduate students: Is multiracial risk different than the sum of each identity?. Eating Behaviors, 41, 101501.
Other references
Acle, A., Cook, B. J., Siegfried, N., & Beasley, T. (2021). Cultural Considerations in the Treatment of Eating Disorders among Racial/Ethnic Minorities: A Systematic Review. Journal of Cross-Cultural Psychology, 00220221211017664.
Franco, M., Durkee, M., & McElroy-Heltzel, S. (2021). Discrimination comes in layers: Dimensions of discrimination and mental health for multiracial people. Cultural Diversity and Ethnic Minority Psychology.
Franco, M. G., & O’Brien, K. M. (2018). Racial identity invalidation with multiracial individuals: An instrument development study. Cultural Diversity and Ethnic Minority Psychology, 24(1), 112.
Jankowski, G., Tshuma, S., & Hylton, M. (2017). Light except Lupita: The representation of Black women in magazines. Psychology of Women Section Review.
Maura, J., & de Mamani, A. W. (2017). Mental health disparities, treatment engagement, and attrition among racial/ethnic minorities with severe mental illness: A review. Journal of Clinical Psychology in Medical Settings, 24(3), 187-210.
McIntyre, J., Daley, A., Rutherford, K., & Ross, L. E. (2012). Systems-level barriers in accessing supportive mental health services for sexual and gender minorities: insights from the provider’s perspective. Canadian Journal of Community Mental Health, 30(2), 173-186.
Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. Bmj, 319(7223), 1467-1468.
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53(5), 985-993.
Vespa, J., Armstrong, D. M., & Medina, L. (2018). Demographic turning points for the United States: Population projections for 2020 to 2060. Washington, DC: US Department of Commerce, Economics and Statistics Administration, US Census Bureau.
Photo credits
- Photo by Suzana Sousa on Unsplash
- Photo by Oleg Sergeichik on Unsplash
- Photo by Christina @ wocintechchat.com on Unsplash
- Photo by Joeyy Lee on Unsplash
- Photo by Aaron Burden on Unsplash
- Photo by Shane Aldendorff on Unsplash
