Resilient Roots: Navigating Intersectional Eating Disorder Care and Latinidad
“No puedes levantarte de la mesa antes de terminar todo lo que hay en tu plato.”
“You cannot get up from the table before finishing everything that is on your plate.”
No matter how full I felt or if the food sitting before me seemed unappetizing, the rules of Latino meal etiquette would come out of my mother’s mouth. Not eating the full plate she or anyone else served me was seen as unappreciative of the effort put into the preparation of the meal. While this taught me to respect the work of those who feed us, I also learned to have few boundaries surrounding food – I was to ignore physical hunger cues and consume all food that was given to me.
Growing into middle childhood, this rule left a sour taste in my mouth as I became acutely aware of others’ serving sizes and how my body compared with theirs. As I examined every inch of my being, along with the comments those close to me would make about my appearance, I decided that I needed to make a conscious effort to change my eating habits. This rapidly escalated into restrictive behaviors and I began to consume media that fueled these habits. However, there was one meal I could not avoid: dinner. The one meal where as a family, we sat together at the table and were not allowed to leave until everybody's plate was clean.
Around this time, I experienced an increase in mental health symptoms exacerbated by the onset of personal trauma. Unable to cope with or speak about the large emotions I was experiencing, I turned to self-harming and purging behaviors to find relief. While the relief I found was short-term, it was still relief, and I actively pursued those small moments of peace.
My body and mind could only take so much, and I wound up becoming a “revolving-door” patient in various psychiatric facilities. These facilities served their purpose in providing me with coping mechanisms and structure for short-term crisis management. What they failed to do was provide a proper diagnosis and referrals for continued treatment catered to disordered eating.
I would be in inpatient ranging from two weeks to six months, and still, regardless of the facility, there was a failure to diagnose me with an eating disorder. Facilities would place me on their eating disorder protocol to monitor my behavior usage, yet when speaking with me, I was told to “let them know when I would start eating again” or they would “forget” to order me a tray of food. Once discharged, my parents would be told that this was merely a phase all teenage girls go through, and to not worry.
Well, thirteen years is quite a phase!
As I got older, I became aware that this was not a unique experience. Latinas are less likely to be referred for further evaluation when compared to non-Hispanic white women, even after controlling for factors such as the severity of eating disorder symptoms, distress, and impairment (source).
The frustrating reality was that it was unlikely I would have been referred to treatment or have my symptoms taken seriously in a system that prioritizes smaller, white, affluent women.
Taking matters into our own hands, my mother called our insurance company to find a treatment center and booked an intake appointment. Finally receiving a diagnosis at the age of 17 validated the years of turmoil I endured. Yet, my struggles were far from over as I was being referred from my program’s partial hospitalization program to a residential facility. Unfortunately, the waiting list for my specific program’s residential was long and I was asked by my team to call other facilities, as they no longer felt outpatient treatment was adequate. After calling all the programs in neighboring states, we found that none accepted our insurance. If I wanted to access residential treatment, I was told that I would need to travel across the country – a cost not feasible for my family. It seemed like I would have to wait months for an opening at the only residential covered by my insurance or that I would not be able to access a higher level of care.
We learned that we could appeal to our insurance for a network gap appeal, which can be used to cover out-of-network treatment as if it were in-network. We found a residential facility that our insurance agreed to partially cover several states away and were put on a payment plan for the difference. This difficulty in accessing adequate care led to decreased motivation and feeling as if I was not “sick enough” to be taken seriously. These financial barriers and insurance gaps are some of the top reasons that ethnically diverse populations do not receive treatment. This treatment gap, barriers to even receiving a diagnosis, and other reasons personal to Latinos such as a family history or stigmatized views on mental illness, internalized stigma, a desire to protect family’s privacy, and a fear of being misunderstood, point towards a need for a more culturally competent process in evaluating Latino clients for the presence of disordered eating.
This need for increased cultural competency is not exclusive to diagnosis or accessing care, but also to the way treatment is approached. Being able to recognize intersectionality (defined by Oxford as “the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage”) within eating disorder treatment is crucial in gaining the full scope of a person’s eating disorder.
While in treatment, I gathered the importance of things such as eating three meals a day and challenging disordered thoughts. But I did not fully embrace recovery until I viewed treatment through an intersectional lens and reclaimed my Latinidad, or the various attributes shared by Hispanic/Latino people without reducing those attributes to a singular trait or characteristic.
Growing up Latina meant that I received mixed messages about my shape and was also told to eat everything out of politeness. I was taught that food is a vital part of my identity and a central component of familial relationships, as the way family passes down stories and how we embrace a collectivist culture by sharing meals. Some messages may have been negative and there were also many benefits to reclaiming my cultural identity during recovery.
Although this discovery came much later, it made a major difference in my healing. The journey to well-rounded care came after many years. Facing the external battle of receiving a diagnosis and navigating insurance brought about immense stress. While I had wonderful providers during my time in treatment, I had to take the initiative to become culturally competent in the eating disorder landscape by educating myself on traditions, values, and barriers that Hispanic/Latinos face. This should not have been my responsibility.
I share my story to urge clinicians, medical professionals, and researchers to question how our current systems impact those struggling with eating disorders, how personal perceptions influence the ways we hear others’ stories, and to help them develop an understanding of how a client’s intersectional identities influence their experience. I also share because there is power in finding community. Increasing the representation of the stories we hear will not only assist others in feeling more comfortable with reaching out for support, but also increase their ability to access proper care to begin with – an opportunity everybody deserves.
