October is LGBT history month, and as the resident eating disorders geek here at Adios Barbie (perhaps I’ll upgrade myself to “specialist” after I finish my MSW), it got me thinking about how little I know about the connection between eating disorders and LGBT population. The default assumptions I’ve heard are that eating disorders (EDs) are more common in gay males than straight males due to increased pressure to be thin and attractive in the gay community, while lesbians have fewer eating disorders than straight women, since they apparently eschew our society’s narrow beauty standards. How much truth, if any, is behind these stereotypical assumptions? Is there a connection or correlation between sexual orientation/gender identity and eating disorders?
I recently attended the NEDA (National Eating Disorders Association) Conference in Los Angeles and I was delighted to discover a session about exploring the interconnections between sexual orientation and eating disorders, given by Courtney Long (MSW, LC, CHt) of Phoenix, Arizona. Courtney shared that her own personal experience with EDs began in her early teens. She had a lot of the risk factors already such as a controlling mother with rigid rules, black-and-white thinking, perfectionism, and suppression of emotions in the family. Around the same time, she had a brief sexual encounter with a female that left her confused and doubting herself for years, always feeling like there was something wrong with her that she couldn’t quite put her finger on. She began exercising compulsively, cutting, restricting her food, and her ED behaviors got more and more serious.
Fast forward to adulthood, and one day, Courtney met a woman and fell madly in love. At that point, coming out didn’t feel like a choice. She knew couldn’t hide her love. Thankfully, her family was very accepting. By accepting her own sexuality and having the support of her family and friends, Courtney then felt she was able to examine her ED behaviors and seek treatment. “I had somehow convinced myself that salad tasted good without dressing,” she joked. “I love ranch dressing, and today I eat it whenever I want.” Now, Courtney is a Life Coach, Hypnotherapist, author, speaker, and more, all to spread the gospel of self-care, authenticity, fluidity, and acceptance.
Courtney’s success story is uplifting, but it’s not always the norm. In an environment that’s not always supportive and accepting, people in sexual minority groups often face additional pressures and challenges that lead to increased self-doubt, shame, and depression. LGBT adolescents are especially at-risk, as they often struggle with accepting their identity, coming out, and fitting in with peers who can be downright cruel. In Courtney’s situation, coming out helped her face and get treatment for her ED, but in other cases, coming out could be so stressful (especially when friends and/or family are not supportive) that it could actually intensify ED symptoms. Does authenticity lead to recovery or is it so painful that it can make existing conditions even worse? Courtney says there’s not much research out there on the topic; based on her experience, some LGBT folks see these factors as related, while others don’t.
So, what about those prevalent assumptions that gay men suffer from EDs much more than straight guys and lesbian women are more “immune” to EDs than heterosexual women? Researchers would say that both of those assumptions stem from a sociocultural perspective. For gay men, sociocultural suggestions state that the values and norms in the gay community place a heightened focus on physical appearance, and that by aiming to attract other men, they are subject to similar pressures and demands as heterosexual women (bodies as sexual objects, and thus, increased body dissatisfaction.) Although the sociocultural perspective is only part of the picture, it turns out that homosexual and bisexual men do in fact have significantly increased prevalence of EDs and ED behaviors including increased dieting, greater fear of gaining weight, lower body satisfaction, and dysfunctional beliefs about the importance of body shape (Kaminski, Chapman, Haynes & Own, 2005.) One recent study found that 6% of gay or bisexual males met the criteria for an eating disorder, compared to 1% of heterosexual males (Feldman & Meyer, 2007).
The sociocultural explanation for EDs does not hold up as well when it comes to lesbian and bisexual women. The suggestion is that these women do not share the same standards of feminine beauty espoused by western culture that straight women do, and thus, will be less likely to subscribe to the thin ideal and supporting behaviors. In fact, some studies have found lower levels of body dissatisfaction than heterosexual women; however, other studies have shown conflicting results, either finding no difference between heterosexual and lesbian/bisexual women among ED symptoms, or even higher levels of EDs (specifically, binge eating disorder) in lesbians compared with straight women. So what gives? This idea that lesbians are immune to EDs just because they supposedly eschew the Barbie beauty standard doesn’t seem to fit, especially when you consider that social is only one-third of “biopsychosocial,” the buzz-phrase in the mental health field for explaining the complex causes behind eating disorders. Sure enough, Feldman and Meyer’s study (one of the most recent and methodologically sound studies on this subject) found that the prevalence of EDs among lesbians and bisexual women is comparable to heterosexual women. Although the sociocultural factors associated with being a sexual minority can increase risk factors for EDs (as with gay and bisexual men), the positive aspects may not be enough to actually decrease risk factors substantially (as we see here with bisexual/lesbian women.)
As for transgender individuals, they often feel tremendous body dissatisfaction. As Courtney put it, “There is so much body dissatisfaction in our society today anyway. Just imagine if you also felt like you were born into completely the wrong body.” Not surprisingly, there is a dearth of research on EDs among transgender individuals, a population lacking in research overall. One attendee in Courtney’s session mentioned that brand new research has found that transgender people with EDs who go through transition recover from their ED based solely on the transition. So, when the body dissatisfaction subsides, the ED tends to go away. An intriguing idea, but I have yet to see the published study so I’m on the lookout for it. To the contrary, another session attendee, who frequently worked with homeless transgender teens and young adults at a center in New York City, stated that she often saw male-to-female transgender people develop EDs as they were transitioning because they felt the need to be delicate, feminine, skinny, and small. Also, being young and uneducated, many of them felt like the only work they could get was sex work, so “passing” was a big deal. They perceived that “passing” as female was the only way to be attractive as a sex worker, the only way to get the money to pay for gender reassignment surgery, so if “passing” meant extreme weight loss, it was a risk they felt they had to take.
At the end of the day, research on eating disorders among people who identify as LGBT is still insufficient and conflicting. However, based on the research we do have, it’s clear that some segments of the LGBT population face increased risk factors for eating disorders and body dissatisfaction. Thus, it is important for mental health practitioners, medical professionals, parents, and educators not to buy in to the assumptions that lesbian and bisexual women are less vulnerable to eating disorders than straight women, or that just because EDs are more common in gay men that they never affect straight men. Although some people unfortunately still discriminate on the basis of sexuality or gender identity, eating disorders do not.
For more information about Courtney Long and to learn about her upcoming memoir, Authentic and Free: A Journey from Shame to Self-Acceptance, visit her website.