Running Head: BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 1

Running Head: BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 1 Bulimia and the Homosexual Male Community Elizabeth Braden Westminster College

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 2 When the term bulimia is spoken of, females were thought to be the only individuals to suffer from it. Like other eating disorders, females are mainly affected by bulimia nervosa; however, an estimated 10-15% of people with anorexia and bulimia are males ( Eating Disorder Information and Statistics, 2014) and while the percentage of men identifying as gay or bisexual is small (3%), studies have shown that 42% of the men who regard with an eating disorder identify as being gay or bisexual (McConville, 2013). What issues increase the prevalence of bulimia in the homosexual male community versus heterosexual males? It is necessary to acknowledge that eating disorders, especially that of bulimia, are not gender or sexual orient focused but may have more of an influence withing those subgroup cultures and it is imperative to educate those for a more comprehensive understanding of the disorder. Bulimia nervosa is an eating disorder involving recurrent episodes of uncontrolled excessive eating (also known as binging) followed by unhealthy actions to remove the food, such as deliberate vomiting, laxative abuse, and excessive exercise (Barlow & Durand, 2011, p. 266). Unlike anorexia, where patients weigh under about 15% body fat, individuals with bulimia nervosa weigh within normal range usually, but are still fearful of gaining weight, have extreme hopes to lose weight, and are overly intensely dissatisfied with their bodies (ADAA, 2012). The influences of bulimia range from biological factors to social factors and psychological influences. Bulimia affects both males and females alike; unfortunately, men are less likely to receive treatment because they believe bulimia to be a woman's disease ( Eating Disorder Statistics, 2014) and women endorse seeking professional help over self-help interventions versus men (Furnham & Davidson, 2012). However, even though women seek out

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 3 treatment more than men, that does not mean that men are not strongly affected by this disease. When examining males and females suffering with eating disorders, they are similar in terms of age of onset, dissatisfaction with current body shape, and controlling weight (Russell & Keel, 2001). However, societal expectations express different ideals of what men and women should look like. For instance, men who are binge eaters or compulsive overeaters may go undiagnosed more than women because of society's willingness to accept an overeating and/or overweight man more-so than an overeating or overweight woman ("Issues for men," 2009). Not only are some of the characteristics of bulimia different between men and women such as societal views of what the male and female body should look like, but also the understanding about bulimia between both sexes is significantly different as well, as seen in a study researching sex differences and beliefs about bulimia nervosa (Furnham & Davidson, 2012). For instance, men confuse the characteristics of bulimia with anorexia (Furnham & Davidson, 2012) - this may because there is not as much research focused on men as there are women with bulimia. Despite similarities and differences of eating disorders amid women and men, there are further issues within the male culture itself specifically unique risk factors in homosexual males. In a study corresponded by Dr. Matthew Feldman and Dr. Ilan Meyer, results showed that gay and bisexual men have higher prevalence rates of eating disorders than heterosexual men (2012). It is believed that amongst the gay men's community, there is a body-centered focus and high expectations about physical appearance (Columbia University's Mailman School of Public Health, 2007). Similar to women's pressures to maintain an ideal body image, it is theorized that homosexual and bisexual men may feel the same.

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 4 The differences between homosexual and heterosexual men and eating disorders can be found firstly within their cultures. Gay men appear to focus on their image more than heterosexual men, by study indications (Heffernan, 1994). For gay men, only self-esteem was negatively related to the importance to others of appearance, weight, and muscularity, perhaps reflecting increased pressure within the gay community to attain the ideal body shape (Yelland & Tiggemann, 2003); this cultural pressure amongst homosexual males creates an increase for vulnerability and dissatisfaction which can lead to a distorted view of the physical body, also increasing the chances of the individual developing an eating disorder. Within the homosexual culture, the gay male ideal body shape is thin; a publication by written by homosexuals (Atkins, 1998) confirms that the gay male ideal does involve not only being slim, but also being muscular (Yelland & Tiggemann, 2003). Because of this cultural ideal of muscular thinness, the pressures of maintaining and losing weight for male homosexuals rises and it can potentially result in engaging unhealthy activities such as binging and purging, or using laxatives, or excessive exercise. This motivation to achieve the ideology of thinness may also be due to sociocultural pressures that focus on the importance of appearance, body shape, and weight existing from within the gay male community (Yelland & Tiggemann, 2003). A strong influence to gay men and achieving their ideal body weight are the toxins of the media environment (McConville, 2013); by this action, they are more likely to be dissatisfied with their body, no matter what it may look like. There is this overwhelming ideology of how the ideal male body should look like, especially that of homosexual men; through television, pictures, and magazines, men are

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 5 bombarded by advertisements suggesting the expectation of what the male body should look like. The media is not the only social factor affecting gay men and their strive to be thin and muscular, but also their own peers have a strong effect on their personal body satisfaction (McConville, 2013). For instance, McConville states that single gay men feel pressure to be thin when looking for a partner (2013). If one cannot succeed in achieving the stereotypical ideal body image, they may not be as comfortable or successful in developing companionate relationships and intimate relationships. If individuals cannot achieve their ideal body shape and size, their self-esteem plummets furthering their dissatisfaction with themselves and their relationships, leading to an increased risk of developing or continuing the habits of bulimia. But influences causing disorders such as bulimia may be more than what's on the surface. It has been demonstrated that those individuals who define themselves in the LGBT community have a greater susceptibility to mental health problems including suicide attempts, anxiety, and depression (McConville, 2013). Studies have shown that eating disorders commonly co-occur with anxiety disorders and a 2004 study found that two-thirds of people with eating disorders suffer from an anxiety disorder at some point in their lives and that around 42 percent had developed an anxiety disorder during childhood, well before the onset of their eating disorder (ADAA, 2012). This correlation to the currency of health problems within the gay community and societal pressures to obtain a certain body image as a homosexual may have influence on the prevalence rate of bulimia amongst homosexuals. A study conducted by the Department of Psychology at Harvard University found that those individuals who identify themselves as homosexual report discomfort with their sexual orientation which can account for

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 6 significant variances in the Bulimia Test-Revised (BULIT-R), Eating Attitudes Test (FAT-26), and Body Shape Questionnaire (BSQ) (Russell & Keel, 2001) which can contribute to the chance of developing an eating disorder. Influences such as environmental cultures and more-than-skin deep mental factors coincide with one another, risking the cause of bulimia. While concerns about eating disorders and obsession with body image was mostly associated with women, studies have proposed that gay men may be a particular subgroup at risk for the development of eating disorders, a number of case studies and clinical series suggest that a disproportionate number of men seeking treatment for eating disorders are homosexuals (Yelland & Tiggemann, 2003). Roughly 25 million men are dieting to lose weight and 21 million men are dieting to maintain weight ( Eating Disorder Information and Statistics, 2014); this continuum of losing and retaining weight can breach the point of harmful eating disorders, such as bulimia. Through studies and research, the prevalence of bulimia amongst this continuum is high within the homosexual male community, by the influences of the gay culture, societal pressures to be thin and muscular, and biological correlations to other disorders that influence bulimia. It is imperative to understand the dangers of bulimia to individuals suffering. Bulimia does not place focus on developing within a specific demographic, but some may be more at risk than others; there are less studies and research on men with bulimia because men are less likely to receive treatment because it has an attached stigma of being a woman's disease ( Eating Disorder Statistics, 2014) and homosexual men struggle with the diagnoses of bulimia and treatment because of their own personal societal limitations within themselves. It is suggested that, eating disorder practitioners should be sensitive to the particular needs of gay and bisexual

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 7 men...by educating them about the effects of the toxic environment...and give them skills which will help to protect them from body dissatisfaction and its consequences (McConneville, 2013). This disorder can affect anyone, Researchers should study the causes of the high prevalence of eating disorders among gay and bisexual men (Feldman & Meyer, 2012), A study reported on male 135 patients found that, future research on the link between sexual orientation and eating disorders would help guide prevention and treatment strategies (Carlat, 1997); if the handful of men within the gay culture who suffer from bulimia seek out help and understanding, further studies can be done to promote research and treatment, which can lead to better recovery.

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 8 References ADAA. (2012). Retrieved from http://www.adaa.org/understanding-anxiety/relatedillnesses/eating-disorders Barlow D.H. & Durand V.M. (2011). Abnormal Psychology: An Integrative Approach. Belmont, CA: Wadsworth Publishing. Carlat, D. J. (1997). Eating disorders in males: A report on 135 patients. The American Journal of Psychiatry, 154(8), 1127-1132. Retrieved from http://web.a.ebscohost.com.ezproxy.westminstercollege.edu/ehost/detail?sid=5473e79aef5a-47b8-a5f7 89936f3b4080@sessionmgr4003&vid=1&hid=4206&bdata=JnNpdGU9 ZWhvc3QtbGl2ZQ== Columbia University's Mailman School of Public Health. (2007, April 14). Gay Men Have Higher Prevalence Of Eating Disorders. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2007/04/070413160923.htm D. Atkins (Ed.), Looking queer: Body image and identity in lesbian, bisexual, gay, and transgender communities, Harrington Park Press, New York (1998) Eating Disorder Information and Statistics. (2014). Mirasol Recovery Centers. Retrieved from http://www.mirasol.net/eating-disorders/information/eating-disorder-statistics.php Eating Disorder Statistics. (2014). National Association of Anorexia and Related Disorders. Retrieved from http://www.anad.org/get-information/about-eatingdisorders/eating-disorders-statistics/ Feldman, M. B., & Meyer, I. H. (2012). Eating disorders in diverse lesbian, gay, and bisexual

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 9 populations. International Journal of Eating Disorders, 40(3), 218-226. Retrieved from http://web.a.ebscohost.com.ezproxy.westminstercollege.edu/ehost/pdfviewer/pdfviewer? sid=9409767b-8b57-4082-83d5-2e0c5a8b569e@sessionmgr4005&vid=2&hid=4206 Furnham, A., & Davidson, L. (2012). Sex differences in beliefs about bulimia nervosa. Social Psychiatry & Psychiatric Epidemiology, 47(1), 67-77. Retrieved from http://web.a.ebscohost.com.ezproxy.westminstercollege.edu/ehost/pdfviewer/pdfviewer? sid=ff76e4ce-0185-4c62-a5c1-c4021ac01c3c@sessionmgr4004&vid=5&hid=4206 Heffernan, K. (1994). Sexual orientation as a factor in risk for binge eating and bulimia nervosa: A review. International Journal of Eating Disorders, 16(4), 335-347. Retrieved from http://web.b.ebscohost.com.ezproxy.westminstercollege.edu/ehost/detail?sid=d13896e3-0040-481b-b8c9 95e61f397211@sessionmgr113&vid=1&hid=120&bdata=JnNpdGU9Z Whvc3QtbGl2ZQ== Issues for men with eating disorders. (2009, December 02). Retrieved from http://eatingdisorderhelpcucamonga.wordpress.com/2009/12/02/issues-for-men-witheating-disorders/ McConville, S. (2013, June 25). Retrieved from http://www.eatingdisorderhope.com/information/eating-disorder/gay-lesbian Russell, C. J., & Keel, P. K. (2001). Homosexuality as a specific risk factor for eating disorders in men. International Journal of Eating Disorders, 300-306. Retrieved from http://web.a.ebscohost.com.ezproxy.westminstercollege.edu/ehost/pdfviewer/pdfviewer? sid=f25e9ad8-f86a-4e66-b748-476543f09b7a@sessionmgr4003&vid=2&hid=4206

BULIMIA AND THE HOMOSEXUAL MALE COMMUNITY 10 The National Institute of Mental Health: Eating Disorders: Facts About Eating Disorders and the Search for Solutions. Pub No. 01-4901. Retrieved from http://www.nimh.nih.gov/publicat/nedspdisorder.cfm Yelland, C., & Tiggemann, M. (2003). Muscularity and the gay ideal: body dissatisfaction and disordered eating in homosexual men. Eating Behaviors, 4(2), 107-116. Retrieved from http://www.sciencedirect.com.ezproxy.westminstercollege.edu/science/article/pii/s147101 530300014X