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HOMOSEXUALITY IN REGARDS TO BODY DISSATISFACTION AND VULNERABILITY TO EATING DISORDERS
April 27, 2011
The society in which we live today places enormous gravity on being skinny and attractive. This causes many people to become dissatisfied with their bodies and experience body-image concerns. These concerns branch from unrealistic body ideals and body-image distortion, both of which are a direct result of societyís pressure to remain thin. Often times, this constant body dissatisfaction causes a person to become more vulnerable to eating disorders (Siever, 1994).
††††††††††† There are many different types of eating disorders but the one thing they all have in common is that they are mental disorders that cause harm to a personís physical and mental health. The two main types of eating disorders, anorexia nervosa and bulimia nervosa, result from a combination of irregular eating habits and a distorted perception of oneís body. Anorexia nervosa is characterized by a personís drastic weight loss, a personís refusal to gain weight, and a personís distorted view of themselves that causes them to fear any type of weight gain. People struggling with anorexia nervosa tend to starve themselves due to a distorted body perception they hold of themselves when in reality they are abnormally skinny. The other major eating disorder, Bulimia nervosa, is somewhat opposite of anorexia nervosa in the sense of eating habits because people suffering with bulimia nervosa tend to eat a significant amount of food in a short period of time. They try to compensate their eating habits by vomiting or using supplements such as laxatives or fasting. People with bulimia nervosa also do not lose nearly as much weight as people with anorexia nervosa. Many anorexia patients binge and purge but remain underweight which allows them to fall in the anorexia nervosa category instead of the bulimia nervosa one. A key difference between anorexia nervosa and bulimia nervosa is that people with anorexia tend to have an excessive amount of control of their eating habits; whereas, people with bulimia have no control of their eating habits during one of their binges (Mental Disorder, 2011).
††††††††††† The two eating disorders described above have very strict criteria that hinder many people with eating disorders from falling into their categories. These people fall under the Eating Disorder Not Otherwise Specified (EDNOS) category. People with EDNOS have obscure eating behaviors but do not meet all of the criteria for anorexia nervosa and bulimia nervosa. Binge eating disorder is an example of an EDNOS. Bing eating disorder is where a person eats a significant amount of food in a set time period but does not compensate for that behavior with purging or fasting (Mental Disorder, 2011).
††††††††††† Eating disorders impact every member of society whether that member is gay, straight or bi. They do however have a far greater prevalence amongst heterosexual females and homosexual males. This is due to the fact that both groups of people look to sexually attract men, who are found to base more of their judgment on looks rather than on personality (Feldman & Meyer, 2006). This notion is even further entrenched in the gay community, where men are expected to be thin, muscular and attractive (Siever, 1994). The increased emphasis on appearance as seen above has caused homosexual men to become greatly dissatisfied with their bodies in turn making them more vulnerable to eating disorders (Siever, 1994). The heterosexual male does not feel the same pressure due to the fact that their target, heterosexual women, do not base as much of their emphasis on physical appearance (Siever, 1994). This paper will investigate whether or not homosexual men truly do have greater body dissatisfaction and increased vulnerability to eating disorders than heterosexual men.
Body Image Dissatisfaction
Hausmann, Mangwelth, Walch, Rupp & Pope (2004) compared 37 homosexual men to two comparison groups of 49 heterosexual men and 24 heterosexual men with eating disorders in order to see the relationship each group had with body image dissatisfaction. Siever (1994) evaluated 59 homosexual men, 53 homosexual women, 63 heterosexual men, and 62 heterosexual women to discover whether or not homosexual men and heterosexual women have a heightened sense of body dissatisfaction and therefore are more susceptible to eating disorders. Yelland and Tiggemann (2003) addressed the prevalence of body concerns by comparing 52 homosexual men with two comparison groups of 51 heterosexual men and 55 heterosexual women.
††††††††††† The 37 gay men who participated in Hausmann et al.ís study were drawn from the gay community of Innsbruck, Austria. They were recruited through the use of announcements which then prompted word to travel throughout the community. The average age was 28.2 years old. The 49 heterosexual men who participated in Hausmann et al.ís study were students at the University of Innsbruck. They were recruited the same way as the homosexual men were with the addition of posted advertisements displayed around campus. The average age was 28.6 years old. The 24 heterosexual men with eating disorders who participated in Hausmann et al.ís study were recruited at clinics at the Innsbruck University Hospital. The average age was 27.2 years old (Hausmann, 2004).
Sieverís study consisted of only University of Washington (UW) and Seattle Central Community College (SCCC) students. The heterosexual female and male students were drawn from the UW Psychology Departmentís Human Subject Pool and classes at SCCC. The homosexual male and female students were recruited through the use of announcements, flyers, and advertisements. They came mainly from the lesbian and gay student organizations located on the two campuses. The homosexual subjects were significantly older than the heterosexual subjects (Siever, 1994).
†Yelland and Tiggemann drew from the Adelaide community of Southern Australia. The homosexual men came from gay groups throughout the city and were recruited through advertisements in a local gay newspaper. The heterosexual men and women were chosen afterwards from community groups to match the homosexual subjects as best as possible. The homosexual men averaged an age of about 32.7 years. The heterosexual men averaged an age of about 33.6 years. The heterosexual women averaged an age of about 28.9 years (Yelland & Tiggemann, 2003).
††††††††††† Haussmann et al. used two methods to conduct their research for their study. The first method they used was the Somatomorphic Matrix. The test is designed to evaluate a personís body image perception. The subjects had to redesign a male body to represent different perceptions they had of what they resembled, of what an ideal body resembled, and of what an average body resembled. The second method Haussmann et al. used was the Body Image Distortion Index. Haussmann et al. calculated the subjectís actual body representation and the body representation the subject had of themselves. Haussmann et al. then subtracted the subjectís perception of himself or herself minus what the subject actually looked like (Haussmann et al., 2004).
†Siever used six methods to conduct his research for his study. The first method he used was the Body Esteem Scale. This method was designed to measure a subjectís body satisfaction and level of importance physical attractiveness had. The BES displays 35 separate items, all of which resembles some part of the body. The first version of the test consisted of the subjects rating how well they felt about each prospective part of their body. The second version of the test consisted of the subjectís opinion on how important each body part was to their sexual partner in terms of attractiveness. The third version of the test consisted of the subject rating the importance of each body part in terms of how they felt about its attractiveness in sexual partners. The second method he used was the Physical Attractiveness Questionnaire. This questionnaire measured how important physical attractiveness and appearance was to the subjects by asking them several questions that were based on the Body Image Survey. The third method he used was the Body Shape Questionnaire. This questionnaire dealt with concerns the subjects have with their body shape. The participants responded to 34 different questions that addressed different issues related to body dissatisfaction. The fourth method he used was the Body Size Drawing. This method was used as a tool for obesity research. It consisted of two sets of drawings portraying a male and a female. The subjects then chose out of the nine figures which one best represented them and which one they would ideally like to be represented by. The fifth method he used was the Eating Disorder Inventory (EDI). This method was designed to assess the psychological and behavioral traits that went along with anorexia nervosa and bulimia nervosa. The EDI usually consists of eight subscales but for this studies purposes he only used three. The three subscales that were used was Drive for Thinness, Bulimia, and Body Dissatisfaction. The sixth method he used was the Eating Attitudes Test (EAT). The test was designed to identify common attitudes and behaviors that were identified in people who had anorexia nervosa or bulimia nervosa. The test consists of 26 different items that makes up three factor subscales and a total score. The factor subscales include dieting, bulimia and food preoccupation, and oral control (Siever, 1994).
Yelland and Tiggemann used a single method to conduct their research for their study. The single method was a questionnaire aimed at examining the gay male ideal. It consisted of six parts. The first part covered the participantsí general information. They were asked to fill out their age, sex, height, weight, and dieting history. The second part measured the participantsí body satisfaction. The method Yelland and Tiggemann used for this was the Body Self Esteem Scale which was described in detail above. Two questions were added to Yelland and Tiggemannís study. The questions assessed the participants desired level of thinness and muscularity. The questions were based off of a seven point scale. The third part of the questionnaire dealt with the participantsí views of other opinions. Yelland and Tiggemann asked several questions regarding what the participants thought the importance others placed on physical appearance, weight, and muscularity. The questions were based off of a five-point scale. The fourth part of the questionnaire focused on the participantsí involvement in terms of exercise. The participants answered a yes or no question on whether or not they have ever exercised. If the participants answered yes they then went on to evaluate eight different reasons for exercising and listing their importance on a five-point scale. The fifth part of the questionnaire evaluated disordered eating. Yelland and Tiggemann used the Eating Disorder Inventory that Siever used along with the exact three subscales he used. Yelland and Tiggemann added a Drive for Muscularity portion to the EDI as well. The final part of the questionnaire dealt with the participantsí self-esteem. Yelland and Tiggemann used a Self-Esteem Scale to measure this. The participants rated themselves on various topics relating to their lives (Yelland and Tiggemann, 2003).
Results and Discussion
††††††††††† Haussmann et al. had very different findings than Siever and Yelland and Tiggemann. Haussman et al. found that homosexual men did not experience greater body image problems than heterosexual men. Homosexual men and heterosexual men had near the same results for all the indices. The most surprising similarity was that they had the same body ideals for fat and muscularity. Heterosexual men also showed no vast differences on the body-image indices when compared to homosexual men. The group containing the heterosexual men with eating disorders showed the greatest variance in terms of actual body image and their body perception as well. The data that Haussmann et al. found was almost completely opposite of what the other two studies found (Haussmann et al., 2004).
Siever found homosexual men were more concerned with their general appearance than heterosexual men. A major difference noted was that homosexual men based their identity on their physical appearance; whereas, heterosexual men based their identity on their physical activity. This shows how much more concerned homosexual men are with their body image. Other results that Siever found were that homosexual men and heterosexual women were similar in the fact that they were deeply concerned about their physical attractiveness as opposed to the homosexual women and heterosexual men. Homosexual men are also like heterosexual women because they both have severe body dissatisfaction as a result of using their bodies as a tool to attract men. Based on the results, homosexual men have worse body dissatisfaction then heterosexual women (Siever, 1994).
Yelland and Tiggemann had similar results as Siever in terms of body image. Yelland and Tiggemann found that homosexual men experience way more body concern than heterosexual men as a result of their lower self-esteem (Yelland and Tiggemann, 2003). Hausmann et al. (2004) cautioned that his results could be a type II-error due to the fact that the sample they selected was too small or the instruments that they used were not sensitive enough to detect abnormalities in homosexual men. This could be the case especially since Siever, Yelland, and Tiggemanís results all showed homosexual men having increased body dissatisfaction over heterosexual men. However, Hausmann et al. (2004) also stated that his results could be different from the majority of other studiesí results due to the fact that Hausmann et al.ís groups showed no selection bias since they did not recruit from clinical populations and send out specific advertisements that addressed eating disorders. Hausmann et al. (2004) stated through the other studies use of this selection bias they drew in populations more concerned with body image then the more representative sample of gay men that Hausmann et al. drew in.
Hausmann et al.ís study had five limitations. The first limitation dealt with selection bias. They felt that selection bias could have impacted one or more of their groups, which would then throw off their data. The second limitation was that no psychiatric history was obtained from two of the groups in their study, the homosexual and heterosexual men. This posed a problem because some undetected cases of eating disorders could be present within these two groups. The third limitation was that the heterosexual men might be falsely identifying themselves as heterosexual due to embarrassment or fear of coming out. The fourth limitation is that the study was done in a small town in Austria where the population size is not very diverse. This makes it very hard to decide whether their findings can be generalized for other societies or if it just applies to this small Austrian town. The final limitation of this study deals with the somatomorphic matrix. This matrix only allows the researchers to measure one aspect of body image dissatisfaction so this study does not take into account the multiple aspects of this problem (Haussmann et al., 2004).†
††††††††††† The study done by Siever has fewer limitations. The first limitation of Sieverís study is that the data drawn for the EAT and the EDI could be faulty due to the need of an alternate scoring method for these two tests. This need draws attention to the epidemiological use of scales present in this study when dealing with clinical populations. The second limitation of this study is that the data drawn for the EAT, EDI, and BSQ when relating to men is in question. This is because when these three tests were originally validated, they were only performed on women. The final limitation of this study is that there could be some bias when dealing with self-report measures. This is inevitable and should not be held against Siever (Siever, 1994).
††††††††††† Yelland and Tiggemann have the least limitations present with their study. The first limitation they have is that their group populations are fairly small so the overall sample size is small. This makes it harder to generalize the findings for a large society. The second limitation is that the homosexual men were recruited specifically from gay support groups, which does not give a completely true representation for all gay men (Yelland and Tiggemann, 2003).
Increased Vulnerability to Eating Disorders
††††††††††† Yager, Felice, Landsverk, and Wiesmeier (1988) evaluated several groups of students at UCLA, one of which consisted of 49 homosexual men, in order to see whether or not homosexuals are more vulnerable to eating disorders. Feldman and Meyer (2007) compared 126 heterosexual men and women to 388 homosexual men and women in order to see the prevalence of eating disorders amongst various groups. Feldman and Meyer (2007) also wanted to see if the gay community had an impact on homosexual men in terms of increased vulnerability to eating disorders.
The homosexual men present in Yager et al.ís study were recruited from the Gay Menís Rap Group at UCLA. The homosexual male group was asked to fill out questionnaires and 48 out of 49 of them did. The large male comparison group in Yager et al.ís study consisted of 120 students who attended the Student Health Service, 111 athletic team members, 59 psychology students, and 10 students majoring in dance. This group was given questionnaires as well that addressed various topics present in the study. The average age of the subjects were 21.6 years old. A fourth of the subjects were graduate students and the rest were undergraduate students. This study also focused on race so 73% of the subjects were Caucasian, 11% were Hispanic, 8% were black, and 8% were Asian (Yager et al., 1988).
††††††††††† Feldman and Meyer used a venue-based sampling to gather their subjects. The venues consisted of business establishments, social groups, out-door areas, and snowball referrals. All of these venues were located in New York City. Feldman and Meyer conducted 524 interviews. After interviewing, they had a total of 126 heterosexual males and females and 388 homosexual males and females. The 126 heterosexual males were all white. The homosexual males and females were split into thirds in terms of race: 34% were white, 33% were Black and 33% were Latino. The heterosexual group had 128 subjects, 51% of them were men and 49% of them were women. The homosexual group had 388 subjects, 50% of them were men and 50% of them were women. The average age of all the subjects was 32 years old (Feldman & Meyer, 2007).
Yager et al. used two methods to conduct their research for their study. The first method they used was questionnaires. They had each subject complete a questionnaire. The questionnaire consisted of questions regarding demographics, homosexual tendencies, and attitudes and behaviors that go along with eating disorders. The two groups had very similar questionnaires; the only difference was that the heterosexual group received questionnaires that left out the section on homosexual tendencies. The second method Yager et al. used was the Eating Disorders Inventory (EDI). The EDI was used in Sieverís study as well as Yelland and Tiggemannís study. The only difference between their studies compared to Yager et al.ís study was that Yager et al. chose to evaluate all eight subscales. This helped Yager et al. evaluate all of the traits that the subjects showed relating to eating disorders, specifically anorexia nervosa and bulimia nervosa (Yager et al., 1988).
Feldman and Meyer used four methods to conduct their research for their study. The first method they used was the World Health Organizationís Composite International Interview. This interview was used to assess whether or not the subjects had anorexia, bulimia and binge eating disorder. The Western Institutional Review Board then reviewed the findings. The second method they used was the Collective Membership Self-Esteem Subscale. It consisted of four items that measured the varying differences of self-esteem amongst the subjects. They used a scale of one to seven to see how much self-esteem a subject had. The third method was just based on whether or not a subject had attended a gym that was predominately attended by homosexual men. The subjects put a 1 if they had attended. The final method used in this study was a questionnaire that asked the level of participation subjects had in various organizations dominated by homosexual men (Feldman & Meyer, 2007).
Results and Discussion
Yager et al., Feldman and Meyer, Yelland and Tiggemann, and Siever all had similar findings in relation to homosexual men having a great vulnerability to eating disorders. Yager et al. found that problems with binge eating, use of contraceptives, and the fear of being fat was significantly more prevalent in the homosexual group then in the heterosexual group. Homosexual men also scored significantly higher on the Eating Disorders Inventory as compared to the heterosexual men. Some of the topics the inventory covered were drive to be thin, awareness of interceptive, bulimia nervosa, body dissatisfaction, and various other related topics Yager et al. stated that the findings regarding the behaviors and attitudes relating to eating disorders being more prevalent in homosexual populations than in heterosexual populations should remain speculative due to the fact that further research should be done (Yager et al., 1988).
Feldman and Meyerís study supported this data by showing that homosexual men had a significantly higher prevalence of eating disorders than heterosexual men. Feldman and Meyer also found that younger homosexual men were more likely to have bulimia then older homosexual men. Feldman and Meyer attributed this to changing social pressures. They also found that homosexuals who participated in gay recreational activities had a much higher prevalence of eating disorders then homosexuals who did not participate in gay recreational activities (Feldman & Meyer, 2007).
†Siever contributed this higher prevalence of eating disorders in the gay community to the heightened emphasis on physical attractiveness within such community (Siever, 1994). He found that the social pressure found in the gay community caused increased body dissatisfaction, which led to an increased risk of developing an eating disorder (Siever, 1994). Yelland and Tiggemannís findings supported the research found above. They conducted a disordered eating scale and found that homosexual men scored significantly higher on it then heterosexual men did especially in relation to bulimia (Yelland and Tiggemann, 2003). He also found that homosexual men have greater body dissatisfaction and a higher percentage of disordered eating.
The limitations found in Yager et al.ís study prompted the cautioning of the results they found. They said that the sample was not very diverse because it consisted of only college students. The sample was also not a representation of the entire homosexual student body since it was only drawn from the Gay Menís Rap Group. Another limitation was that the study was a cross-sectional, noninterview study. This and the fact that the nonhomosexual students were asked no questions regarding their sexual life warrants the concern that some of the heterosexual individuals were in fact homosexual (Yager et al., 1988).
†Feldman and Meyer did not have as many limitations, which is partially why they had such sound data. Their first limitation was that they based their data on nonprobability sampling. This is a problem because it could result in bias. The second limitation was that the sample population was not incredibly large. This is an important thing to notice when dealing with eating disorders because they have a low base rate to begin with (Feldman & Meyer, 2007).
††††††††††† Heterosexual men and homosexual men face many different issues and attitudes. The gay environment that most homosexual men live in is very critical of appearance. While heterosexual men still face this pressure from heterosexual women, it is not nearly as strong. Homosexual men are faced with a constant pressure to be thin and muscular which often time results in an increased body dissatisfaction and a lower self-esteem. This increased body dissatisfaction causes an increased risk of developing attitudes and behaviors that correspond to eating disorders.† It can then be concluded that homosexual men have an overall greater body dissatisfaction and higher vulnerability to eating disorders when compared to heterosexual men.
†††††††††† Although these findings are fairly consistent throughout the studies, further research is warranted. Hausmann et al. (2004) stated that further studies that focused on having a large number of homosexual participants, who were recruited in a way that minimizes selection bias would help confirm their data. Siever (1994) feels that further research should be done on how the pressures the gay community promotes are affected by the whole coming out process, homophobia, and initial assimilation into the community itself. Yelland and Tigemann (2003) feel that the gay men ideal of being slim yet muscular needs to be further researched in terms of how they are able to balance those somewhat opposing goals. Yager et al. (1988) agrees with Hausmann et al. on the fact that larger community based studies are needed. Feldman and Meyer (2007) used DSM criteria to evaluate the prevalence of eating disorders within a population and feel that further research needs to be conducted in the same manner. Feldman and Meyer (2007) also feel that further research needs to be done using more than just college students and clinical samples in their studies. This goes along with what Yager et al. and Haussmann et al. stated in terms of broadening the population sample to all ages. The final aspect that needs to be further researched within this topic is how different races are affected by homosexuality in terms of increased body dissatisfaction and heightened vulnerability to eating disorders.
Feldman, M.B., & Meyer, I.H. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3). 218-226. doi: 10.1002/eat
Hausmann, A., Mangweth, B., Walch, T., Rupp, C.I. & Pope, H.G. (2004). Body-image dissatisfaction in gay versus heterosexual men: Is there really a difference? Journal of Clinical Psychiatry, 65(11). 1555-1558.
Mental Disorder. (2011). In Encyclopedia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/375345/mental-disorder
Siever, M.D. (1994). Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. Journal of Consulting and Clinical Psychology, 62(2). 252-260.
Yager, J., Kurtzman, F, Landsverk, J. & Wiesmeier, E. (1988). Behaviors and attitudes related to eating disorders in homosexual male college students. American Journal of Psychiatry, 145(4), 495-497.
Yelland, C., & Tiggemann, M. (2003). Muscularity and the gay ideal: body dissatisfaction and disordered eating in homosexual men. Eating Behaviors, 4. 107-116. doi: 10.1016/S1471-0153(03)00014-X
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