Stephanie Armstrong Covington knows all about the misperceptions associated with eating disorders and black women. During an eight-year period, Covington battled with anorexia, bulimia and binge eating. “It was a horrible experience because there is so little information about it and I felt very isolated,” she says. “I also felt like I was falling outside of the strong black woman archetype, which felt very shameful.”

For black women, the belief that women of color aren’t troubled by eating disorders can cause embarrassment and denial among sufferers as well as their friends and family—and that prevents them from getting needed medical treatment. Today Covington is a spokesperson for the National Eating Disorder Association (NEDA) and author of Not All Black Girls Know How to Eat, a Story of Bulimia. But she remembers a time she visited her family, very thin but also able to down large helpings of food: “I could eat for five hours straight and people would say, ‘Oh my God you never gain any weight!’ I would think to myself, That is because I was in the bathroom 10 times. Did you not know that I was throwing up?”
Blogger Erika Nicole Kendall, who formerly weighed 330 pounds and chronicled her weight loss journey to becoming a “personal trainer, nutritionist and bikini competitor,” discusses with the role denial plays in eating disorders. According to Kendall, such denial in the black community can lead to binge eating being confused with obesity. And the confusion is shared by some in the medical field, says Gayle Brooks, PhD, vice president and chief clinical officer at the Renfrew Center of Florida.

Unlike obesity, binge eating disorder (BED) is officially classified as a mental health disorder in the current Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). But like obesity, BED can lead to severe physical health consequences, including reduced bone density, muscle loss, dried out hair and an abnormally slow heart rate.

BED’s mental health connection manifests when people eat large amounts of food because they’re being driven by something other than hunger. “There’s a tendency to eat when you’re not hungry,” Brooks explains. “And [there are] other cues, such as emotions or stress, that trigger food consumption.”

BED is a psychiatric and psychological problem that is more about the ways a person deals with emotional stress, trauma, anxiety and depression; obesity, in contrast, often has more to do with eating a nutritional diet and getting proper exercise or perhaps dealing with medical issues such as thyroid problems. BED is defined by recurrent and persistent episodes of binge eating, according to the National Eating Disorders Association, or NEDA.

In addition, Brooks says, “A binge isn’t necessarily defined by eating a certain number of calories; it’s just consuming a larger quantity of food than what would be considered normal.”

What’s more, American culture may play a role in the development of BED. The excessive amounts of food advertisements on billboards, the Web and TV that bombard us each day teach people to view food as a source of comfort and pleasure. “We learn to turn to food to manage emotional situations at an early age,” Brooks says. “And even though we are a culture that is obsessed with thinness, we are also a culture that is obsessed with food.”

Interestingly, the classification of BED as a mental health disorder has opened the way for continued discussion about eating disorders and their impact in the black community. Although NEDA states that BED seems to affect African Americans and whites equally, Brooks says that there does seem to be some differences in terms of cultures and ethnicities in terms of the types of eating disorders that seem to be most predominant.

For example, blacks and whites are affected by different cultural pressures to meet an ultra-thin beauty ideal. “There may be less pressure or emphasis [for African Americans] on trying to diet and engage in behaviors that lead to weight loss,” Brooks explains. “If there’s less pressure [to be super skinny], then it may be that this is protective in some ways and stops an African-American person from moving into a binge-purging cycle.” But, she warns, blacks could be more prone to binge eating instead.

But the bigger issue is not just eating disorders. In the black community, many people fear talking about mental health issues in general. “We’ve got to expand this dialogue to really look at the complex interplay between obesity and eating disorders,” Brooks says. “We’ve got to help the African-American community understand that this is an illness that requires something more, and we need to educate doctors and others in the health community as well.”

The key to addressing eating disorders such as BED—and other mental health issues—is by breaking the silence, Covington says. “When I was 12 years old, I was raped by my uncle,” she shares. “After that, I shut down emotionally. Eventually, if you shut down, there are going to be some ramifications from that; [your issues] are going to come out in some way.”

Recovering from eating disorders, or any mental health issue, requires getting the proper treatment and support. “You can’t do it alone,” Covington says. “We have to be willing to go outside ourselves to seek the help we need.”