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Research Problem: Eating disorder literature has well-established a correlation between childhood trauma and development of eating disorder symptomology. One type of trauma that is often overlooked in eating disorder research is that of racial stress faced by ethnic minorities. The literature on racism and eating disorders tends to focus on the transdiagnostic construct of disordered eating behavior rather than specific DSM-5 diagnoses. As such, the current literature review examined the findings regarding associations between racial stressors and disordered eating behavior.

Methods: The current literature review between Nov 2007 and August 2020 searched 3 databases, PubMed, CINAHL, and PsycInfo for English-language publications pertaining to conflict in racial identity (e.g., racism and acculturative stress) and disordered eating (keywords provided below). As there is limited primary research examining the association between racial stress and clinical diagnoses of eating disorders, this literature review expanded the search term of “eating disorder” (and its associated subcategories) to include other types of disordered eating, a behavior that often precedes the development of clinically diagnosable eating disorders. The literature search yielded 42 results, 81% (N=34) of which were included in the review; the included articles examined the relationship between disordered eating and various racial identity conflicts, including racism, ethnic identity exploration, perceived discrimination, and acculturative stress. 32 articles were cross-sectional design, 1 article was a theoretical analysis, and 1 article was a review.

Results: The included literature looked at multiple minority populations, including Asian Americans, African Americans, Hispanic Americans, and Native Americans, and overwhelmingly found that perceived racism is consistently associated with disordered eating, especially for minority women. Current research suggests that across minority groups, the mediating factor in this association is self-reported stress. Other studies (N=7) produced mixed findings (i.e., positive correlations or null results) regarding the relationship between acculturative stress and disordered eating behavior. The magnitude of the relationship often differed based on the ethnicity and gender of the population being studied. Finally, racial teasing and discrimination were associated with disordered eating, disturbed body image, and depressive symptoms primarily among females across multiple races.

Conclusion: While there is a body of research examining racial stress and disordered eating behavior, samples were primarily drawn from college students, and this body of research relies almost entirely on cross-sectional methodology. Moreover, the current review did not identify any studies that examined clinically-diagnosed eating disorder populations or any studies that utilized a longitudinal design. As such, the current review indicates a need for prospective longitudinal studies examining relevant risk factors and their relationship to the development of disordered eating behaviors over time in minority populations. Additionally, it is important for physicians to assess for racial stress as a potential factor contributing to the physical and mental health outcomes of minority patients, especially among minority women.



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