Eating disorders and gay male culture

If one were to read many of the popular magazines aimed at a male demographic, particularly those skewed to the LGBT population, images of what is considered masculine or desirable would be visible front and center. Ryan Reynolds, Channing Tatum, Ryan Gosling—shirtless photos of these men and many others along with their six-pack abs serve as a major selling point for items ranging from clothing to movies. For many men, particularly those who identify as gay, these media images of what’s attractive aren’t necessarily in line with the reality of their body shapes or sizes. What used to be an issue acknowledged more readily in the female population, eating disorders and/or disordered eating patterns, is becoming more prevalent among males.

In addition, there appears to be a stronger vulnerability to these problems in the gay male population. And if a drug addiction and/or alcoholism is already present, this can produce a complex treatment puzzle with a multiplicity of issues. So why is it that gay men are seeming to fall more and more into the trap of process addictions such as eating disorders?
 

Cultural factors

Gay male socio-culture places a premium on physical appearance, and nowhere is this more prevalent than in the gym—a place where heightened masculinity is on display. With many gay men not feeling pleased with their body “just as it is,” the gym can be a breeding ground for increased dissatisfaction. At its extreme, body dysmorphia can be the end result, personified by an individual looking in the mirror and literally seeing something reflected back at him that doesn’t match the reality of what’s there.

Even within the gay male population, there are numerous variations on attitudes toward body shapes/sizes, and with those variations spring a variety of eating disorders. There are “twinks”—those who place significance on youth and being thin, thus perhaps inviting in restricted eating. At the other end of the spectrum are “bears”—those who eschew the predominant gay cultural visual of being overly thin and lean toward having more weight and/or muscle mass. This perhaps could bring about some forms of overeating, thus contributing to yet another form of disordered eating.

None of this is to say that all gay men fall on the continuum of eating disorders, but there is stronger evidence being shown that the gay male population is more susceptible to these issues than previously known. Some of the factors contributing to this issue are internalized homophobia and not wanting to appear/act feminine, social anxiety, depression, and feelings of self-consciousness strengthened by the comparisons gay men might make among themselves.

According to a recent study conducted by the Columbia University Mailman School of Public Health and the National Development and Research Institute, gay men are three times more likely than heterosexual men to have an eating disorder. This research found that 15% of gay men report having some form of eating disorder in their lifetime, ranging from binge eating to bulimia to anorexia.

Growing evidence of the prevalence of male eating disorders was recently found in a survey by the British Broadcasting Company (BBC), which found a 66% increase in hospital admissions for men with eating disorders in the last decade in the UK alone. One can posit that the majority of the men affected by eating disorders are gay, because of the body-conscious impact of the culture itself.

As treatment centers become more accustomed to treating the whole person from a holistic framework rather than compartmentalizing issues, it comes as no surprise that there has become a stronger awareness of process addictions. Operating on the same part of the brain affected by drugs and alcohol, food intake—necessary for life—can become complicated for men who feel as if they are being judged based on the shape of their body.

It is not uncommon for men who have gotten sober from drugs/alcohol to segue into eating disorders as a cross addiction, perhaps further exacerbated by the use of anabolic steroids or growth hormones, only to make a return to their earlier addiction. How can the treatment community, particularly those specializing in eating disorder treatment and/or issues specific to the LGBT population, respond to these issues and treat them appropriately?
 

Male-focused perspective

Practitioners need to seek further training in the areas of eating disorders and the LGBT population and learn how to ask questions early and often that speak specifically to men. It is simply not enough to look at eating disorders through a female theoretical lens; asking probing questions as they relate to food from the male perspective is much needed.

Further studies need to be conducted to learn more about the prevalence of eating disorders as it relates to males and to focus on how to identify those food-related behaviors that can become problematic for men. Support groups for males need to become more of the norm rather than islands unto themselves.

As the taboo of male eating disorders gets lifted, so perhaps will the willingness of those affected by them to address these issues head-on rather than hide in the shadows—a behavior not unlike living in the traditional closet that many of those in the LGBT population already occupy.

Helping men to reconcile the reality of their own unique bodies with those images shown by mass media is critical for the well-being of men affected by some form of eating disorder. This can be done through a healthy exploration of what constitutes traditional masculinity, defined by lean bodies and muscles, along with a newer representation of the norms and values associated with being male-identified.

Jeffrey Zacharias, LCSW, CADC, is President/Clinical Director of New Hope Recovery Center in the Lincoln Park neighborhood of Chicago. He also maintains a private practice and is a Registered Dual Disorder Professional (RDDP) with several years of clinical experience in the addiction and mental health fields. His areas of interest include working with the LGBT community. His e-mail address is jeffrey@new-hope-recovery.com.