Q&A: Equity in the Treatment of Eating Disorders

It has been commonly recognized that Eating Disorders do not discriminate, as they can affect all persons regardless of race, ethnicity, social economic status, or religion, etc. Despite this postulation, Eating Disorders are often underdiagnosed in many cultures due to the lack of knowledge or understanding.

Joy Ssebikindu, LPC, and Malak Saddy, RD, LD of the Center For Discovery will be presenting Best Practices for Building Diversity and Inclusion in the Treatment of Eating Disorders at this year’s Columbia River Eating Disorder Network Conference taking place April 27th at Lewis & Clark College. Content will explore diversity, culture, and the negative impact of Anglo-centric treatment modalities in the outpatient and inpatient treatment of Eating Disorders.

We chatted with Joy and Malak about their upcoming presentation, and why this training topic is essential learning for all mental health practitioners.

Learn more about the CREDN conference here

Tell us a bit about your backgrounds and how you became interested in the treatment of eating disorders?

Joy Ssebikindu: In honesty, I feel into the need for me to treat eating disorders. I am ethnically Ugandan American. Both of my parents escaped their country under the cruel regime of Idi Amin. Like most immigrant families, my parents were transparent about their desire to give my sisters and I a better life, and they pushed us academically because in their experience that was the only way to be noted as successful. In college, through varying experiences, I began realizing that there were more career options outside of what my culture would consider prestigious and notable so I explored the impact that I could have as a psychotherapist. I began working with family systems, athletes and soon recognized that many of my clients were coming to me in desperation, searching for someone who looked like them who “got it” without their needing to explain or justify their experiences. I guess you can say that the rest is history – here I stand as an advocate!

Malak Saddy: I was born in Toronto, Canada to American Lebanese parents and by the age of 6 lived in 4 different countries before we settled in Michigan. I learned from the strong women my family how food could bring so many people together and how it has strong roots to my culture and traditions. Becoming a dietitian allowed me to incorporate the two things I love most, food and talking and helping people. During my college years I was able to job shadow an eating disorder dietitian in private practice all at the same time that a close family member of mine was struggling with their own eating disorder. When I look back at how things played out, I truly feel like all the stars aligned and lead me to continue to specialize in eating disorders. Not a day goes by that I don’t love what I do or am not grateful to all the clients that allow me to walk their journey with them. I grateful that I get to help my clients and their family find their voice and give them the strength and hope that they may need to recover.

Eating disorders have traditionally been seen as a “white woman’s problem”, with the reality being that they affect those of all genders, races, ethnicities and socioeconomic statuses. What are some of the ways you have seen the failure to fit this stereotype affect the diagnosis and treatment of marginalized populations? 

Most of the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders is based on the notion that there is are normative values. However, what we are seeing is that these diagnostic markers are not always sensitive to varying cultures. Many clients/patients of marginalized communities will go undiagnosed simply because clinicians are not screening for eating disorders within their own multidisciplinary team. We have seen and heard how diverse clients at times feel as if the westernized treatment creates a superior or “all size fits all” treatment mentality, which leads the client to experience more shame around their own traditions. For example, we often assume that those who fall victim to the development of an eating disorder are susceptible to the “thin ideal”, which may not be the case depending on a person’s value. Clinically, we must be willing to explore specific distortions within ourselves and potential body image differences within our clients through individualized care.

Why do you think it is important for all practitioners to be cognizant of potential biases and the negative impact of Anglo-centric treatment modalities in counseling and therapy–perhaps those that aren’t working explicitly in eating disorder treatment?

As clinicians, whether it be in or out of the eating disorder realm, we need to come from a place of curiosity and awareness. The failure to acknowledge our client’s perspective of their own culture, background, and religion can add to the shame that they may already feel. The stigma around seeking support for mental health issues can be deeply rooted in diverse populations and if we are dismissive of that it can add to feelings or urges of isolation and not feeling as though they can be heard. 

Is there anything else you want to share about your upcoming presentation, or your work in eating disorder treatment?

We recognize that the topic of diversity and inclusion can be a difficult conversation to engage in. In this day and age, such topics are emotional charged and we often get feedback that in conversation about race, ethnicity, and the recognition of White privilege, members of majority groups often feel defeated and powerless. That is not our goal! Bringing awareness to issues of diversity and inclusion, we hope that audience members walk away with the confidence to continue the conversation.

Learn more about the upcoming 2019 Columbia River Eating Disorder Conference program