Assessment of Eating Disorders With Diverse Client Groups
Historically, EDs have been thought of as conditions primarily affecting White females from high-socioeconomic-status households. However, recent epidemiological research in the United States has demonstrated that some EDs may be more common among racial and ethnic minorities than originally thought. For example, recent data have suggested that BN and BED may be more common among racial and ethnic minorities than among non-Hispanic White Americans (Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011). Although some EDs may be relatively common among racial and ethnic minorities compared with White Americans, special consideration should be given when assessing and diagnosing EDs in these groups. First, culturally normative behaviors may resemble ED symptoms (e.g., overeating, fasting); however, these behaviors would not be counted as a symptom of an ED (Becker, 2011). Second, researchers have noted that ED symptoms manifest differently across cultures. For example, researchers have observed the following variations; (a) Asian women with EDs do not universally endorse fear of gaining weight or drive for thinness (Lee, Ho, & Hsu, 1993), (b) the use of alternative compensatory behaviors such as herbal purgatives among Fijian women (Thomas, Crosby, Wonderlich, Striegel-Moore, & Becker, 2011), and (c) variability in the extent to which Native American women with EDs endorse overevaluation of shape and weight (Lynch, Crosby, Wonderlich, & Striegel-Moore, 2011). Third, a distinct possibility exists of miscommunication between the client and the counselor conducting the assessment. For example, clients from diverse cultures may misunderstand questions about concepts that do not exist in their culture of origin (Becker, 2011); in turn, counselors may misinterpret clients' responses. To enhance accurate ED assessment among culturally diverse client groups, counselors should take a flexible, curious approach; ask open-ended questions; provide concrete examples; and ask for clarification.