2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Understanding Eating Disorders in Gay Males

The National Association of Anorexia Nervosa and Associated Disorders estimate that men account for 1 million of the roughly 8 million Americans that suffer from eating disorders (McMurray, 2013). Within the gay community there is a hidden epidemic of eating disorders. Gay men are up to three times more likely than heterosexuals to have clinical or subclinical eating disorders (Feldman, 2007). How can we understand exactly why homosexuality is a risk factor for eating disorders in males (Hospers, et. al., 2005). We now know empirically that there is an atypical overrepresentation of homosexual males in clinical eating disorder samples. Men suffer in shame and silence. The risk of mortality for males with eating disorders is higher than it is for females (Raevuoni, 2014).

Challenging Assumptions

It is essential that we challenge some of our fundamental assumptions about eating disorders; negative body image doesn’t discriminate, it plagues both sexes (Fidelman, 2013). For almost two decades we have known that eating disturbances remain undiagnosed and therefore untreated. Further clinical identification and intervention is essential (Williamson, 1999). We have a cultural obligation to improve easier access to outstanding psychological care. The focus must primarily be on de-stigmatizing eating disorders. At this point in time it is abundantly clear that there are multiple stigmas about gay males that suffer from eating difficulties. Anderson (1999) has argued that the bias against diagnosis and appropriate treatment is multi-determined. There is a bias that comes from self, from society, from health care professionals and from insurance companies. Now is the time for further development of multicultural competencies in relation to gay men.

Vulnerability

The Gay and Lesbian Medical Association is the world’s largest and oldest association of lesbian, gay, bisexual and transgender (LGBT) healthcare professionals and recommends that further research on internalized homo-negativity, internalized homophobia, internalized heterosexualism, minority stress, gender socialization and identity development needs to occur (Isacco, et. al., 2012). From a broader mental health perspective this association argues that there is a deficit model that is utilized in addressing psychological care for gay men. We know that this population is at increased risk for self-harm, suicidal ideation, eating disorders, legal and illegal substance abuse, tobacco use, panic attacks, depressive symptoms and underutilization of health care services.

Cultural Pressures

Our culture is driven by the desire to maintain beauty and youthfulness. We believe that Obesity and premature aging must be avoided above all else. There are very narrow parameters in terms of being muscular and lean. When we reflect upon body image in gay and straight men, it is important to recognize the power of media and social influences (Morgan, et. al., 2009). There is a significantly higher value within the gay community placed on physical attractiveness. Superficial beauty fuels self-esteem, identity, success, desirability and the unconscious wish to be envied. The hype and selling of male beauty in media and culture comes with a tremendous psychological and emotional cost (Dotson, 1999). Men arguably continue to experience similar social injustices to women in advertisements and magazine covers based on sex appeal.

Body Dissatisfaction

Historically the emphasis on eating disorders always characterized and described “female maladaptations.” For example, our cultural stereotype of Anorexia Nervosa has been narrowly defined; the poster child for this illness has been a Caucasian, wealthy, perfectionistic girl. As social scientists we recognize that Anorexia Nervosa must have a significant impact on all races, genders, ages and socioeconomic classes (Mondi, 2014). It is always important to recognize the essential nuances and subtle differences in our full understanding of body dissatisfaction. There are clinical differences in females body dissatisfaction in comparison to body dissatisfaction in males. The female beauty ideal focuses on weight and being slim. The male homosexual ideal is not only about being lean but also muscular (Yelland, et. al., 2003). There is empirical evidence revealing that body dissatisfaction is related to having a higher Body Mass Index (BMI) more peer pressure and lower masculinity scores (Hospers, et. al, 2005). Siconolfi (2009) argues that there is a harsh competition within the gay community with very rigid standards of male beauty. Researchers have coined the term “buff agenda” among gay men being the fantasy that muscularity will grant social and sexual desirability and power (Halkititis, 2001). This framework further describes the cultural zeitgeist of muscle as compensatory for experiences of disempowerment and minority stress.

Assessment and Treatment

Current research on gay males with eating disorders reveals that assessment tools utilize language geared to females which has fostered misconceptions about the nature of male eating disorders. We now know that males with Anorexia Nervosa usually exhibit low levels of testosterone and Vitamin D and therefore have a high risk of osteopenia and osteoporosis. Testosterone supplementation is often recommended (Sabel, 2014). In addition, having an all-male therapeutic environment is strongly recommended. Males in treatment can feel out of place when primarily surrounded by females within the therapeutic milieu. Treatment planning ideally should focus on decreasing compensatory behaviors such as vomiting and excessive exercise to control their body weight. We also know that men are more likely than women to binge eat rather than restrict food intake (Jackson, et. al.,2002).

Conclusion

In conclusion we are embarking on a critical journey that will sharpen our understanding of treating significant illnesses more effectively. The quality of our patient care will be greatly enhanced by completing a thorough diagnostic assessment process and complete evaluation. We have the potential to facilitate the treatment process by simple clinical identification of eating disorder symptomatology and the opportunity for early intervention. A comprehensive approach to providing excellent care to the gay community (Isacco, et. al.,2012) should be multi-faceted and include medical stabilization, addressing health challenges, strength building, skills training, follow up care and maintenance. Clinical rigor and further longitudinal research will provide mental health professionals with better assessment tools and individually tailored treatment strategies that foster physical health and psychological resiliency.

For further information you may reach Dr. Rachel Bush by email at drrachelwbush@gmail.com.

Have a Comment?