In many ways, Stephanie Doswell is your regular college student in a T-shirt and flare-legged jeans. But she is also anorexic, bulimic and African-American, a combination so rare that it sometimes goes unrecognized.

"If someone sees a sickly, thin white person, they automatically think that they have anorexia," said Doswell, 19. "If someone sees a sickly, thin black person, they don't think that they have anorexia."

She adds sarcastically: "Because blacks don't get anorexia."

While their numbers are probably small, black anorexics face a host of unique problems, including inadequate diagnoses from doctors not expecting to find eating disorders in African-Americans.

Anorexia has been thought of as a disease affecting rich, white females since the 1940s because it primarily affects girls from well-to-do Caucasian families.

Recent studies seem to confirm that black anorexics are extremely hard to find. Last month Ruth Striegel-Moore of Wesleyan University in Connecticut reported in the American Journal of Psychiatry that although anorexia is believed to affect 1 percent to 2 percent of the general population, none of the 1,061 young black women in their study was anorexic.

But many experts doubt that black anorexics are as rare as studies have suggested, though experts are left guessing at how prevalent the disease is in minorities.

Traditionally, African-American girls have been thought to have some protection from eating disorders such as anorexia nervosa and bulimia nervosa because of a greater acceptance of larger body size in the African-American community, said Gayle Brooks, an African-American psychologist specializing in eating disorders at the Renfrew Center in Florida.

But this alleged protection from eating disorders appears to weaken as blacks take on the values of the mainstream culture, Brooks says.

"I think that there are a lot of African-American women who are really struggling with their sense of personal identity and self esteem that comes with being a part of this culture that does not accept who we really are," Brooks said.

For years anorexia (characterized by refusal to eat enough) and bulimia (characterized by binge eating and purging) was only studied in white females, leaving gaps in medical knowledge about eating disorders and how they affect minorities.

For example experts are not sure whether black girls from high-income families are more likely than their poorer counterparts to develop eating disorders, as is believed to be the case for white girls.

Striegel-Moore acknowledges that her study may have underestimated the number of blacks with anorexia nervosa because she had too few girls from affluent black families.

Similarly, psychologists typically search for anorexia in adolescents, the age group commonly found to have the disorder in white girls. However, experts question whether anorexia may develop later in African-Americans.

Thomas Joiner, a professor of psychology at Florida State University, tested whether racial stereotypes influence the recognition of eating disorders. He asked 150 people to read a fictional diary of a 16-year-old girl named Mary and rated whether they thought the girl had an eating disorder.

For some the diary was labeled "Mary, 16-year-old Caucasian." For others it was labeled "Mary, 16-year-old African-American."

More people said the subject had an eating disorder when she was labeled white than when she was labeled black.

"Race mattered," Joiner said. "There's the idea in people's minds that African-American girls tend not to get eating disorders. And that influenced their judgments."

Joiner and his colleagues also found that many health care professionals were unable to recognize black anorexics.

One 17-year-old African-American girl from Washington, D.C., said her doctors did not diagnose her properly, even though she has been purging since age 10 and at 5 foot 7 has weighed as little as 95 pounds.

"The doctors just thought I had a stomach thing. ... They gave me antibiotics and rehydrated me and sent me home," said the girl, who replied to an e-mail request from the Tribune asking African-American anorexics to share their stories.

Many researchers and clinicians studying anorexia nervosa say that becoming anorexic is more a consideration of one's social group.

Girls from poor families face an additional risk because they are not likely to be able to afford treatment, which can cost as much as $30,000 for a month of in-patient care.

Doswell typifies some of the issues surrounding anorexia in black women.

Her condition was verified through her therapist, Keitha Austin of Newport News, Va., who received written permission to confirm that Doswell is an African-American female with anorexia.

She starts each day with eight melon-flavored gummy rings.

"I don't want a booty like J. Lo," Doswell said. "I don't want to look like Beyonce because she is fat."

At 5 feet 4 inches tall--about average--Doswell weighs 93 pounds, less than 97 percent of women her age. She wears a size 3, she says, because she likes her clothes baggy.

Doswell said she envied her white, Hispanic and Asian friends, who were thin and preoccupied with weight.

Her roller coaster with eating disorders began in anticipation of an exchange program trip to Japan.

"I didn't want to be fat on the trip," Doswell said. "So, I just stopped eating. It was that simple."

Thirteen pounds later, Doswell was still not happy. So she forced her weight lower into the upper 90s.

By spring 2002 she was eating only rice or fruit and exercising incessantly, stealing laxatives and throwing up the little food she consumed. But she did not know that her behaviors had a name.

"I went on-line one day and found out that what I was doing was actually a disease," she said.

Web offers support

The Web has become a haven for young women with eating disorders. The issue of race and stereotypes are hot topics for members of the Colours of Ana Web site, created as a support system for girls and women of color with anorexia and other eating disorders.

Many girls on the coloursofana.com site wrote that they have heard negative comments from other blacks saying that they developed anorexia because they are trying to be white.

"I have an eating disorder because I am sick, not because I am wanting to be white," wrote one woman. "We need to get past this sort of exclusivity. It is just not helping."

Tennis star affected

In the mid-'80s Zina Garrison, a professional tennis star, looked around the tennis world and did not see anyone who looked like her.