CNN —
At the start of the Islamic month of fasting, Ramadan, Habiba says she is “terrified” at the thought of fasting this year.
After her disordered eating habits developed into bulimia and binge eating disorder during her teenage years, she says the ritual of abstaining from eating and drinking from dawn to dusk could exacerbate the need to further restrict her eating and risk getting into a toxic cycle.
But the decision to refrain from the practice feels like neglecting an important part of her faith, she says.
“I don’t trust myself to fast because I know…I’m starting to enjoy the feeling of hunger and I’m scared of what it’s going to do to me,” said the 30-year-old Briton. based Muslim editor who asked CNN to only use her first name for privacy reasons. “I’m sad. I feel like I’m missing out on a truly spiritual experience.”
Habiba was nine years old when she first felt the urge to get sick, she says. By the age of about 16, she said she skipped meals, tracked calories, passed out as a result of hunger, overexerted, and vomited at least 15 times a day.
“I wouldn’t wish anything like bulimia on anyone because it’s like an addiction.”
Habiba is not alone in her experience. A growing number of Muslim doctors and psychologists are trying to bridge the gap between faith leaders and believers like Habiba, who say they are marginalized when trying to access support in their own communities as well as the public health system.
“Minorities are underrepresented. It’s not that they don’t have or suffer from eating disorders, but there is all this stigma about who comes for help,” said Dr. Omara Naseem, a UK-based counseling psychologist specializing in the treatment of eating disorders. These are “invisible and arbitrary” diseases that transcend age, religion, gender and sexuality, she added.
“It is an act of worship to take care of your body and your health. So go and get the right help you need,” she said.
During Ramadan, Muslims are encouraged to eat a balanced meal before sunrise and then break their fast with a date and water at sunset, followed by a larger meal. Worshipers also engage in other forms of practice, including increased prayer, increased charity, volunteerism, and sharing meals together.
However, daylight fasting can mask restrictive eating patterns associated with eating disorders, Naseem said. Exercising control and experiencing hunger while fasting could create a desire to quickly eat large amounts of food at iftar—the breaking of the fast after sunset—which can lead to feelings of out of control and “embarrassment.” and triggering a “binge-purge cycle” to reset recovery, she added.
According to the Qur’an, people who are sick or traveling are not required to fast as long as they make up the fast once they are healthy, or feed less fortunate Muslims throughout the month.
So if someone has an illness or condition that has been confirmed by a doctor, they don’t need to fast, said Imam Nadim Ali, a Muslim faith leader and licensed professional counselor based in Atlanta, Georgia.
For example, children and the elderly as well as people who are pregnant, menstruate or have to take medication every day are exempt from fasting.
However, community and society-wide taboos mean that mental illness is not believed in the same way as physical illness, both Naseem and Ali said. That means those who choose not to fast because of mental illness face “guilt and shame” from their communities and society, Naseem added.
Habiba said she has childhood memories of having her body constantly checked by members of her extended family, behavior she says is symptomatic of the cultural pressures some South Asian and Muslim girls face as they enter womanhood.
When she was 15, she recalls an uncle telling her she had “got fat” after returning from a family trip to Turkey. “Comments like this stick forever,” she said. In the years that followed, her weight dropped drastically.
At the same time, she recalls being told by extended family members that she could no longer play outside and ride with her cousins. Instead, she was encouraged to hang out with her girlfriends and play with makeup.
Despite having “liberal” parents, she believes her eating disorder was partly a response to pressures to fit into strict gender roles assigned to her by her community and society at large.
When she was about 16, Habiba said her eating disorder symptoms worsened until her parents took her to a local doctor. She received outpatient psychiatric care in a child psychiatric facility until she was 18, when she was transferred to an adult psychiatric facility.
However, she says the cultural differences between her and the white therapists she saw meant they couldn’t understand the nuanced pressures she faced as a woman in her community; and how they were inextricably linked to their eating disorder.
“I’ve had white therapists who just didn’t get it and were really just very patronizing about things I wanted to talk about or struggled with.”
Farheen Hasan, a 27-year-old research psychologist from Bristol, south-west England, agrees that therapists need to understand specific cultural constraints.
At the age of 18, Hasan said, she began to exhibit disordered eating habits in the form of food avoidance, excessive exercise, and an obsession with healthy eating. She said that every year she faced an internal struggle over whether or not to fast during Ramadan.
“I think we need access to therapists who understand our culture, religion and struggle — and who can provide professional guidance and support,” she told CNN via email.
Habiba and Hasan’s stories reflect the systemic challenges people from underserved communities face when accessing mental health support.
Although people of color have higher rates of some mental health disorders than whites, they face greater disparities in seeking help due to institutional discrimination and interpersonal racism and stigma. According to a report by the US National Association of Anorexia, Black, Indigenous and People of Color are significantly less likely to be asked by a doctor about symptoms of an eating disorder and are half as likely to be diagnosed or treated for nervosa and associated disorders.
Halima Eid, a licensed professional clinical consultant and co-founder of AMALY, a California-based nonprofit dedicated to challenging the stigma of mental health in Muslim communities, said it’s difficult for people in those spaces can be to access the information you need.
Eid founded AMALY in 2020 to provide accessible therapy services, workshops, support groups and educational conversations tailored to her local Muslim community in San Diego, California. It also offers online services that extend to Muslims worldwide.
Last spring, she founded a virtual self-help group to help Muslims with eating disorders during Ramadan. She said that after the screening process, about 30 people initially registered in two cohorts, including Muslims from the US, Australia and the UK. She intends to lead the same group this year.
“It’s a very lonely experience to be alone with an illness or disorder,” she said. “Then there is guilt that they do not please Allah and that they are not good Muslims. So we challenge perfectionism in Islam, perfectionism as Muslims during Ramadan because many people are fighting.”
Both Eid and Naseem, the UK-based consulting psychologist, use their Islamic and medical knowledge to help Muslims seeking support from mental health professionals who have a life experience similar to that of women who practice Islam.
“I can offer a unique perspective…it helps you apply your skills to groups that might not engage or wouldn’t feel comfortable speaking to someone who isn’t from their background,” said Naseem, who created one Ramadan Guide with Diet and Faith Advice for Muslims with Eating Disorders.
Habiba says her bulimia reached a tipping point a few years ago when she came home from a friend’s baby shower and became ill after eating cake and sweets.
“I remember just looking at my body and saying I don’t like it. I don’t like the way I look and I don’t think I’ll ever love myself, but I think I just have to accept it,” she said. “I don’t know if I can ever say I’ve made a full recovery. I know I still have that voice… in my head. But now it’s quieter.”
Now she said she can keep her eating disorder in check by identifying her triggers and forcing herself to eat when she’s drawn to restrictive diet patterns.
Ramadan and Eid celebrations can trigger her eating disorder, she said, because she’s been under pressure to eat large amounts of food at iftar and has received derogatory comments from family members who may not understand her decision not to fast .
Hasan, the Bristol-based research psychologist, said that in their position, Muslims need “social acceptance” from community leaders.
“A lot of stress and psychological distress would be reduced if we had acceptance and recognition in the community that people are struggling in different ways, and we should understand and accept them rather than stigmatize them,” she said.
Habiba said she still misses the communal aspect of breaking the fast during Ramadan, attending family meals and counting down the days until Eid al-Fitr, the celebrations that mark the end of Ramadan.
“I feel like I’m going to be kicked out of the club,” Habiba said, adding that she hopes to get to a point in the future where she can fast again and be safe from losing her faith, Rather than wanting to limit their calorie intake, their motivation is.
Ali, the Atlanta-based imam and advisor, suggested ways Muslims with eating disorders can engage in the holy month alongside fasting, including reading the Koran, attending nightly tarawih prayers and donating to a feeding program.
He said faith leaders and family members should recognize the challenges Muslims with mental health issues face during Ramadan and provide them with guidance to break the intergenerational cycle of shame and guilt that exists in society.
“Islam is a religion that does not want people to risk their lives to engage in forms of worship,” he said. “I think the most important thing is that we religious leaders can show empathy for the least among us, the most vulnerable among us.”