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What is the relationship between homosexuality and the prevalence of eating disorders?

Jordan Levy

4/23/09

 

Introduction

 

            While eating disorders have traditionally been associated with young white upper-middle-class females, research regarding the topic has extended to other subgroups. Many studies have examined the prevalence of eating disorders among homosexual males, for whom the “gay ideal” involves “not only being slim, but also being muscular (Yelland and Tiggemann, 2003). Often times, modern gay culture inspires sentiments of increased feminine gender role identification or increased pressure to maintain thinness to attract a male partner in homosexual males (Russell and Keel, 2001), which results in a noticeably higher amount of bodily dissatisfaction and disordered eating behavior among homosexual males than in heterosexual males. It has been observed that homosexual males place a greater importance on all aspects of the physical self: body build, grooming, dress, and attractiveness (Silberstein et al., 1989), which can often hold gay men up to unattainable standards. Consequently, the role of homosexuality among male eating disordered patients is significant, as there is often a great deal of emphasis placed on physical appearance. Not only are homosexual men more likely than heterosexual men to have eating disorders, but the notion of the “gay ideal” may actually contribute to the development of disordered eating in homosexual males.

Heightened Emphasis on Appearance in the Gay Community and its Effect on Eating Disorders

Procedure

            In a study by Silberstein et al. (1989), 71 self-identified homosexual men (average age 24.2) and 71 self-identified heterosexual men (average age 23.08) who showed no significant difference in measure of percent overweight index completed a questionnaire regarding five different aspects of body image.

Body image dissatisfaction was assessed using two different techniques. The first was Body Size Drawings (BSD), which consisted of nine drawings of a male figure, with each successive drawing gradually increasing in size from extremely thin to extremely obese. Subjects were asked to choose the image they thought represented both their current appearance, or perceived image, and the drawing that represented what they ideally wanted to look like, or ideal image. The second measure of body image dissatisfaction was the Body Esteem Scale (BES), which listed 35 aspects of physical appearance and required subjects to rate their satisfaction with each item. These items were categorized into three subcategories: physical attractiveness, upper-body strength, and physical condition.

Self-esteem was measured with the 10-item Rosenberg Self-Esteem Scale, in which subjects rated each item as they did for the BES.

Self-roles were measured with the Self Roles Inventory, which was used to assess the difference between the two groups of men in the importance of physical appearance. This involved rating one out of thirteen different roles as the most important to themselves, and then rating the rest of the roles relative to the most important one. Since only three of the roles pertained to physical appearance, the other ten were not analyzed in this study.

Disordered eating was measured with the 26-item Eating Attitudes Test (EAT), a measure of attitudinal and behavioral characteristics commonly found among anorexic and bulimic individuals. Three subscales were obtained from this test: the Dieting subscale, the Bulimia and Food Preoccupation subscale, and the Oral Control subscale.

Finally, reasons for exercise were evaluated in a 24-item Reasons for Exercise Inventory (REI), which represented seven general reasons: exercising for weight control, for fitness, for health, for improving body tone, for improving overall physical attractiveness, for improving mood, and for enjoyment.

Heightened Emphasis on Appearance in the Gay Community and its Effect on Eating Disorders

 Results

The results of the study were conclusive with the concept of increased physical self-awareness among homosexual males. In the study of body image dissatisfaction, the BES revealed that heterosexual men are more satisfied with body parts that contribute to the ideal male body build and were more satisfied with their bodies’ functional aspects. The BSD revealed that the ideal body image of homosexual males was thinner than that of heterosexual males, and homosexual men had a wider gap between their perceived and ideal body images than did heterosexual males.

The results of the self-roles experiment demonstrated that among the gay subjects, physical appearance was significantly more important to their sense of self than the heterosexual subjects. The heterosexual men considered the role of being physically active of significantly greater importance to their sense of self than did the gay men. Physical activity is a stereotypically masculine attribute, and since homosexual men often identify better with the female gender roles, these results are conclusive with the idea that the identification with female gender roles in gay men can contribute to eating disorders.

The reasons for exercise study revealed that heterosexual males indicated that they exercised significantly more often than gay men to improve their fitness, to improve their overall health, and for enjoyment. On the other hand, gay men stated that they exercised more often to improve their physical attractiveness.

Both the self-esteem and disordered eating studies revealed no difference between homosexual and heterosexual males.

Overall, the results of this study support the notion that physical appearance is of heightened importance for homosexual males than for heterosexual males. The ideal figure for homosexual men was smaller than that of heterosexual males, and homosexual males showed attitudes associated with irregular eating habits. Additionally, exercise in the homosexual group was motivated by a desire to improve physical appearance, whereas in the heterosexual group it was motivated by desires for internal improvement. The results of the study suggest that the heightened emphasis placed on physical appearance in the gay community can promote behavior typically associated with eating disorders.

Is Homosexuality Itself a Specific Risk Factor for Eating Disorders in Men?

Procedure

In a study by Russell and Keel (2001), 58 homosexual (average age 29.09) and 64 heterosexual men (average age 26.11) who did not differ significantly in ethnicity, body mass index, education, or socioeconomic status, participated in a survey that asked about age, height, weight, ethnicity, sexual orientation, education level, occupational level, relationship status, age of identification of sexual orientation, and comfort level with sexual orientation. The participants also completed six additional standardized questionnaires: Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSE), Bem Sex-Role Inventory (BSRI), Eating Attitudes Test-26 (EAT-26), Bulimia Test-Revised (BULIT-R), and the Body Shape Questionnaire (BSQ). Some of the questions were aimed at women, so they were adapted to be appropriate for men.

Is Homosexuality Itself a Specific Risk Factor for Eating Disorders in Men?

Results

            The results of the study suggest that sexual orientation accounted for a significant portion of variance in depression, self-esteem, comfort with sexual orientation, bulimic symptoms, anorexic symptoms, and body dissatisfaction. In the study, homosexual men reported greater levels of distress and eating pathology, as well as less comfort with sexual orientation compared to the heterosexual men.

            Additionally, measures of disordered eating were highly correlated with depression and poor self-esteem. Lower levels of masculinity, which are typically associated with homosexuality, were also associated with worse self-esteem, more depression, more anorexic symptoms, and greater body dissatisfaction. The study also states that because homosexual men reported greater disordered eating than heterosexual men, even after controlling for levels of general psychological distress, homosexuality may actually be a specific risk factor for eating disorders among males.

Increased disordered eating in gay men is sometimes attributed to increased femininity. However, in this study, homosexuality did not correlate any more with femininity than did heterosexuality. Additionally, femininity did not correlate with eating pathology in men, meaning that this study does not support the concept of female gender identification as contributing to the relationship between homosexuality and male eating disorders. As a result, the study proved conclusive in that it demonstrated a clear relation between homosexuality and eating disorders. However, it does not explain which specific aspects of homosexuality contribute to the development of eating disorders -- an important aspect of understanding the issue that could be beneficial for its prevention and treatment.

Which aspects of homosexuality contribute to eating disorders?

Procedure

While the previous study demonstrated a relationship between male homosexuality and eating disorders, it failed to determine which specific aspects of homosexuality created this connection. A study by Meyer et al. (2000) sought to investigate this, and examined the role masculinity and femininity played in the prevalence of eating disorders among homosexuals.

The study consisted of 100 men and women: 20 homosexual women (average age 19.85), 20 homosexual men (average age 20.1), 30 heterosexual women (average age 19.9), and 30 heterosexual men (average age 20.0). The participants participated in three different measures: a background on their sexual orientation, the Bem Sex Role Inventory, and the Eating Attitudes Test.

Femininity as a Risk Factor

Results

The Bem Sex Role Inventory, which requires participants to rate how well they identify with masculine, feminine, and undifferentiated traits, demonstrated that heterosexual men were more masculine than homosexual men.

On the Eating Attitudes Test, which assesses the behaviors and attitudes of anorexic, bulimic, and control samples, homosexual men scored higher than heterosexual men, indicating a greater tendency toward disordered eating behaviors among the male homosexual population than the male heterosexual population.

The study demonstrated a significant relationship between masculinity and femininity scores and the Eating Attitudes Test. For men, there was a negative correlation between masculinity and bulimia scores (r=-.56) and a positive correlation between femininity and oral control scores (r = +.46). This suggests that homosexual men that score high in femininity are more likely to restrict food intake, and homosexual men that score high in masculinity are less likely to engage in bulimic behaviors.

         In the study, femininity was associated with high levels of eating psychopathology, supporting “a model of eating disorders in homosexual men and women for whom femininity is a specific risk factor and masculinity is a protective factor”. This can be attributed to several different things.

         The first is the notion that the western “thin ideal” places increased importance in the feminine role orientation. The second explanation, which is more commonly accepted, is the result of an inner conflict between the homosexual male’s feminine role-orientation and society’s masculine view of the ideal man. This conflict leads to tension and emotional distress. In accordance with this model and other current models of eating psychopathology, it is suggested that perhaps bulimic behaviors can be used to reduce the negative emotions associated with inner gender-identity conflict. However, further research on the subject is necessary to determine the theory’s validity.

         Despite this, the study determined that it is the femininity associated with male homosexuality that can often be a specific risk factor for the development of eating disorders.  

The “Gay Ideal” and its Contribution to Eating Disorders

 Procedure

         A study by Yelland and Tiggemann (2003) suggested that the notion of a “gay ideal” body could be a significant factor in the risk for developing eating disorders among male homosexuals. They studied 3 different groups: 52 homosexual men (average age 32.7), 51 heterosexual men (average age 33.6), and 55 heterosexual women (average age 28.9), who were included because they, like gay men, strive to be attractive to men and are susceptible to poor body image. All participants filled out a survey measuring the following factors: general information, body satisfaction, importance to others, exercise, disordered eating, and self-esteem.

         The general information survey included information such as age, sex, height, weight, and whether the subject had ever been or was currently on a diet. BMI was calculated from the information provided.

         Body satisfaction was measured using the Body Esteem Scale (BES), which asks subjects to rate their feelings about 35 different body parts and functions. Additionally, participants were asked to rate how satisfied they were with their body shape, weight, and muscularity, as well as their desired level of thinness and muscularity.

         The survey on importance to others involved rating how important they thought their physical appearance, weight, and muscularity were to other people. A high score in this domain would indicate pressure from within one’s own culture to attain the “gay ideal” body shape.

         Exercise habits were determined by first asking the subjects whether they ever exercised. Those who did exercise then rated eight different reasons for exercising: weight control, fitness, mood, health, attractiveness, enjoyment, to build muscle, and body tone. Subjects were also asked whether they had every used steroids, shakes, or other food preparations to build muscle.

         Disordered eating was assessed on three behavioral subscales (drive for thinness, bulimia, and body dissatisfaction) on the Eating Disorder Inventory (EDI)-2. Drive for Thinness refers to a drive for or intense pursuit of thinness and a fear of being fat. The Bulimia scale assess subject’s tendency to think about and engage in bulimic behaviors. Finally, the Body Dissatisfaction scale assessed dissatisfaction with the subjects’ overall appearance, weight, and specific parts of the body. Additionally, the subscale Drive for Muscularity was designed for this study, which translated items from the Drive for Thinness scale to be applicable to muscularity.

         The final part of the survey, self-esteem, was measured using Rosenberg’s Self-Esteem Scale. Subjects rated a number of statements about themselves, and a high score in this domain indicated high self-esteem.   

The “Gay Ideal” and its Contribution to Eating Disorders

 Results

         The results of the body satisfaction survey demonstrated that homosexual men did not differ significantly from heterosexual men on body esteem, but they actually had significantly higher body esteem than the women. Gay men also did not differ significantly from heterosexual men on the single items regarding satisfaction with overall body shape or weight, but it was determined that they were less satisfied with their overall muscularity. Gay men did not differ significantly from heterosexual men in drive for thinness, but they had a greater drive for muscularity than heterosexual men.

         In the disordered eating survey, a slightly greater amount of homosexual men than heterosexual men indicated that they had been on a diet. Homosexual men scored significantly higher than heterosexual men on Body Dissatisfaction, as well as Drive for Thinness. Gay men also scored higher than straight men on the Bulimia scale and Drive for Thinness, and more of the gay men had used steroids or shakes in order to increase muscularity. 

         The results of the exercise survey demonstrated that homosexual men were less likely than heterosexual men to exercise, but that gay men rated weight control, fitness, mood, health, and body tone as significantly more important reasons for exercise than straight men. It was noted that gay men also rated attractiveness and building muscle as significantly more important reasons to exercise than heterosexual men.

         The importance to others survey concluded that gay men indicated that their appearance was significantly more important to other people than did heterosexual men. There was no difference between gay and straight men in the importance to others of weight, but gay men indicated that muscularity was more important to others than straight men.

         Finally, the self-esteem survey found that gay men had significantly lower self-esteem than straight men, and were very similar in this dimension to the heterosexual women.

         Overall, the study demonstrated that homosexual men experience more body concern and disordered eating than heterosexual men. Interestingly, on some measures they score as poorly as did women, suggesting that it is not gender that determines susceptibility to poor body image and disordered eating, but rather sexuality or gender-identification.

         The results of the body dissatisfaction survey also proved to be interesting. While gay men demonstrated a greater desire for muscularity than heterosexual men and an equal drive for thinness to women, their self-esteem scores showed them to be as satisfied with their bodies as straight men, and more satisfied than the women. This suggests that although gay men do not experience body dissatisfaction to the same effect as women, they experience a similar level of “drive” for the ideal body.

         The major conclusion of this study was the notion that the gay “ideal” is not only being thin, but muscular as well. Gay men desired a substantially greater increase in muscularity than straight men or women, and were more dissatisfied with their current level of muscularity than straight men. Gay men believed their physical appearance was more important than did straight men, particularly their muscularity.  The survey concluded that although restricting food intake can be dangerous for women, it can be even more dangerous for gay men if they are simultaneously engaging in excessive exercise to attain the “gay ideal” body shape of thin and muscular.

Discussion

         The results of the four studies unanimously conclude that male homosexuality is a significant risk factor for the development of eating disorders. Though it is unclear exactly what about homosexuality increases this risk, Meyer et. al (2000) suggest that the internal gender identification conflict that many homosexuals experience can cause tension and anxiety that is relieved by engaging in disordered eating behaviors. Additionally, Russell and Keel (2001) suggest that the feminine gender identification of many homosexual males causes them to identify with the more commonly acknowledged “thin ideal” for women. The same study also noted that decreased levels of masculinity, also associated with male homosexuality, are associated with greater body dissatisfaction and more anorexic symptoms.  While Russell and Keel (2001) suggest that the ideal figure of a homosexual man is smaller than that of a heterosexual man, the results of the study by Yelland and Tiggemann (2003) clearly point to homosexual men having a greater desire for muscularity than heterosexual men. While several of the studies show somewhat conflicting results, all four acknowledge a distinct relationship between male homosexuality and eating disordered or bodily dissatisfied tendencies. It is the way that these tendencies are manifested, however, that differs between the studies.

         Overall, it is clear that homosexuality in men increases the risk for eating disorders. However, research is still needed to determine whether it is the actual homosexuality that causes this phenomenon, or if it is simply higher levels of femininity (in both men and women) that lead to a heightened sense of physical self-awareness and bodily concern.  Nonetheless, it is clear from the above studies that a clear relationship exists between male homosexuality and the prevalence of eating disorders.

Works Cited

Meyer, C., Blissett, J., & Oldfield, C. (2000). Sexual Orientation and eating

       psychopathology: The role of masculinity and femininity. International

       Journal of Eating Disorders. 29(3): 314-318.

Russell, C.J., & Keel, P.K. (2001). Homosexuality as a specific risk factor for

       eating disorders in men. International Journal of Eating Disorders. 31(3):         300-306.

Silberstein, L.R., Mishkind, M.E., Striegle-Moore, R.H., Timko, C., & Rodin, J.

       (1989). Men and their bodies: A comparison of homosexual and heterosexual

       men. Psychosomatic Medicine. 51(3): 337.

Yelland, C., & Tiggemann, M.E. (2003). Muscularity and the gay ideal: Body

       dissatisfaction and disordered eating in homosexual men. Eating Behaviors.

       4: 107-116.

 

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