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Wolfe EC, Snorrason I, Laky ZE, Miyares P, Klare D, Fang A, Summers B, Phillips KA, Wilhelm S, Greenberg JL. Clinical characteristics among sexual minority and heterosexual women with body dysmorphic disorder. Body Image 2024; 49:101687. [PMID: 38471234 DOI: 10.1016/j.bodyim.2024.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
Body dysmorphic disorder (BDD) is a common disorder associated with substantial comorbidity, impairment, and poor quality of life. Research on subcultural variations of BDD is limited but may impact assessment and treatment of the disorder. The current study examined clinical features in a sample of sexual minority (SM; n = 43) and heterosexual (n = 155) women with diagnosed BDD. Participants completed self-report and clinician-administered measures of demographic and clinical characteristics. Results indicated largely similar clinical features across groups with some exceptions: compared to non-SM women, SM women were younger (M = 25.50 vs 31.96 years, p < .001), had better BDD-related insight (M = 14.51 vs 16.26, p = .01), endorsed a greater number of disliked body parts, and were more likely to express preoccupation with body build (OR = 4.6, 95% CI [2.0, 10.9]), chin/jaw (OR = 4.7, 95% CI [2.1, 10.3]), and shoulders (OR = 10.1, 95% CI [2.7, 37.9]), possibly reflecting nuanced beauty ideals within the SM community. There were no significant group differences in other body parts of concern, BDD severity, or depression. Future studies are needed in larger, more inclusive samples to explore the relationship between diverse identities on BDD and its associated features.
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Affiliation(s)
- Emma C Wolfe
- University of Virginia, 485 McCormick Road, Charlottesville, VA 22903, USA.
| | - Ivar Snorrason
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Zoë E Laky
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA; American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | - Peyton Miyares
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Dalton Klare
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Angela Fang
- University of Washington, 3751 West Stevens Way NE, Seattle WA 98195, USA
| | - Berta Summers
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Katharine A Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, NY 10065, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Jennifer L Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
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Brown TA, Klimek-Johnson P, Siegel JA, Convertino AD, Douglas VJ, Pachankis J, Blashill AJ. Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals. Int J Eat Disord 2024; 57:648-660. [PMID: 38279188 DOI: 10.1002/eat.24150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. METHODS N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. RESULTS Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. DISCUSSION Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. PUBLIC SIGNIFICANCE This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Patrycja Klimek-Johnson
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Alexandra D Convertino
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Valerie J Douglas
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - John Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Aaron J Blashill
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
- Department of Psychology, San Diego State University, San Diego, California, USA
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3
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Askew AJ, Randall A, Alvarez JC, Elbe CI, Caravelli N, Gonzales M, van der Star A, Blashill AJ. Examining the association of structural stigmas with body image-related outcomes among sexual minority individuals. Body Image 2024; 48:101652. [PMID: 38141492 DOI: 10.1016/j.bodyim.2023.101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
Sexual minority individuals display heightened body image disturbance, which is associated with negative health outcomes. Structural stigmas are associated with negative health outcomes among sexual minority individuals, but the association between structural stigmas and body image is not understood. Using a linear regression approach, we examined how U.S. state-level structural racism and structural sexual minority stigma were associated with body image-related outcomes including eating pathology, appearance and/or performance-enhancing drug (APED) misuse, and dysmorphic concern. Participants were 942 cisgender sexual minority individuals ages 18-30, with approximately equal representation among non-Hispanic/Latinx White, Black, Asian, and Hispanic/Latinx individuals. There was not a significant main effect of state-level structural sexual minority stigma on body image-related outcomes. In states with higher structural racism, Hispanic/Latinx participants endorsed higher APED misuse, and this interaction was not significant among non-Hispanic/Latinx White individuals. This pattern was not found among Black or Asian participants, nor was it replicated for dysmorphic concern or eating pathology. Findings suggest that reducing exposure to structural racism could reduce APED misuse among Hispanic/Latinx individuals.
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Affiliation(s)
- Autumn J Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Alyson Randall
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Jordan C Alvarez
- Department of Psychology, Auburn University, Auburn AL, United States
| | - Connor I Elbe
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Nicolas Caravelli
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Manuel Gonzales
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Arjan van der Star
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States.
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4
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Alvarez JC, Denning DM, Castro Lebron J, Ho V, Chen S, Brown TA. Differential effects of community involvement on eating disorder prevention outcomes in sexual minority men. Eat Disord 2024:1-16. [PMID: 38375554 DOI: 10.1080/10640266.2024.2319946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Prior research has been conflicted on whether gay community involvement serves as a risk or protective factor for body image and eating disorders (EDs) in sexual minority men (SMM), perhaps given that prior research has examined community involvement unidimensionally. The present study examined whether non-appearance-based ("social activism") and appearance-based ("going out/nightlife") community involvement differentially predicted ED prevention outcomes in SMM. SMM (N = 73) enrolled in a randomized controlled trial of an ED prevention program completed measures of community involvement, drive for muscularity, body dissatisfaction, and bulimic symptoms at pre-intervention, post-intervention, and 1-month follow-up. "Social activism" community involvement moderated intervention effects for drive for muscularity and body dissatisfaction scores, but not bulimic symptoms, such that those who placed higher importance on social activism demonstrated expected improvements, while those who placed lower importance on social activism did not exhibit expected improvements. "Going out/nightlife" community involvement did not moderate intervention outcomes; however, greater importance of going out/nightlife was associated with increased body dissatisfaction. Findings support that the impact of community involvement on body image and ED risk for SMM may be nuanced. Encouraging community involvement through activism could help enhance ED prevention efforts for SMM.
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Affiliation(s)
- Jordan C Alvarez
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Dominic M Denning
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Veronica Ho
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sabrina Chen
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
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Le TP, Jin L, Kang N. Sexual, gendered, and internalized racism's associations with disordered eating among sexual minority Asian American men: Emotional eating as mediator. Eat Disord 2023; 31:533-552. [PMID: 37032549 DOI: 10.1080/10640266.2023.2201024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Research related to disordered eating among sexual minority Asian American men is scarce. Thus, the present study utilized an intersectional framework to examine how three different forms of racism (i.e. sexual racism, gendered racism, and internalized racism) are associated with disordered eating among sexual minority Asian American men, as well as the mediating role of emotional eating. A cross-sectional survey containing the study's measures of interest were administered to participants. The final sample consisted of 180 sexual minority Asian American men. Both sexual racism and internalized racism were positively associated with disordered eating whereas gendered racism was not associated with disordered eating Emotional eating mediated the association between internalized racism and disordered eating, though it did not mediate the association between sexual racism and disordered eating. Researchers and practitioners are encouraged to utilize an intersectional framework that takes into account multiple forms of racism, especially sexual racism and internalized racism, when considering this underrepresented population's disordered eating. Results also demonstrate the importance of addressing racism in eating disorder prevention efforts among sexual minority Asian American men.
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Affiliation(s)
- Thomas P Le
- Department of Psychology, Bryn Mawr College, Philadelphia, Pennsylvania, USA
- University of Maryland
| | - Lily Jin
- Department of Psychology, Bryn Mawr College, Philadelphia, Pennsylvania, USA
- University of Maryland
| | - Naru Kang
- Department of Psychology, Bryn Mawr College, Philadelphia, Pennsylvania, USA
- University of Maryland
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6
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Ünsal BC, Demetrovics Z, Reinhardt M. Stronger together: community participation, structural stigma, and depression among sexual and gender minority adults in 28 European countries. Soc Psychiatry Psychiatr Epidemiol 2023; 58:657-669. [PMID: 36434298 PMCID: PMC10066166 DOI: 10.1007/s00127-022-02385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Although discriminatory laws, policies, and public attitudes (i.e., structural stigma) are linked to adverse mental health outcomes among sexual and gender minority (SGM) populations, little attention has been paid to protective factors, such as community participation, about which inconsistencies exist whether it ameliorates or exacerbates mental health burdens. Thus, we examined the mediator roles of identity disclosure and victimization and the moderator role of structural stigma in the association of community participation with depression. METHODS Data from the EU-LGBTI-II survey assessing community participation, identity disclosure, victimization, and depression among sexual minority men (n = 62,939), women (n = 38,976), and gender minority adults (n = 15,845) in 28 European countries were used. Structural stigma was measured as discriminatory legislation, policies, and societal attitudes using publicly available data. RESULTS Findings showed that community participation predicted lower and higher levels of depression through identity disclosure and victimization, respectively. For sexual minority men and women, structural stigma moderated the indirect effect through identity disclosure, with a larger effect in higher structural stigma countries. Only for sexual minority men, the indirect effect through victimization was also moderated, with a larger effect in high-stigma countries. For gender minorities, no moderation effect was found. CONCLUSIONS Community participation is differentially linked to depression through identity disclosure and victimization, and as a function of structural stigma. It can be a double-edged sword, especially for sexual minority men in high-stigma countries, who are expected to pay the price while enjoying its benefits, highlighting the targets and considerations for interventions.
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Affiliation(s)
- Berk C Ünsal
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Melinda Reinhardt
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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McGuire FH, Goldbach JT, Senese JG, Cabrera JR, Schrager SM, Duncan AE. Longitudinal association of homonegative school climate with body dysmorphic disorder among cisgender sexual minority adolescents: Testing mediation through proximal minority stressors. Body Image 2023; 45:86-93. [PMID: 36842424 DOI: 10.1016/j.bodyim.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
In a US national cohort study of cisgender sexual minority adolescents (SMAs), we prospectively (1) assessed whether within-person changes in homonegative school climate (i.e., school contextual factors that lead SMAs to feel unsafe or threatened) were associated with risk of probable body dysmorphic disorder (BDD) and (2) tested whether internalized homonegativity and negative expectancies mediated this association. Data came from consecutive time points (18-month, 24-month, 30-month) of the Adolescent Stress Experiences over Time Study (ASETS; N = 758). The Body Dysmorphic Disorder Questionnaire measured probable BDD. Sexual Minority Adolescent Stress Inventory subscales measured past 30-day minority stress experiences. Multilevel models were specified with person mean-centered predictor variables to capture within-person effects. Across one year of follow-up, 26.86% screened positive for probable BDD at least once. Model results indicated significant total (risk ratio [RR]=1.43, 95% credible interval [CI]=1.35-1.52) and direct effects (RR=1.18, 95% CI=1.05-1.34) of homonegative school climate. Internalized homonegativity was independently associated with probable BDD (RR=1.28, 95% CI=1.12-1.46) and mediated 49.7% (95% CI=12.4-82.0) of the total effect. There was limited evidence of mediation via negative expectancies. Implementing SMA-protective school policies and targeting internalized homonegativity in clinical practice may reduce the prevalence and incidence of probable BDD among cisgender SMAs.
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Affiliation(s)
- F Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - John G Senese
- Center for LGBTQ+ Health Equity, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Juan R Cabrera
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Alexis E Duncan
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
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Shepherd BF, Maki JL, Zelaya DG, Warner Ş, Wilson A, Brochu PM. Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory. Eur J Investig Health Psychol Educ 2023; 13:170-186. [PMID: 36661763 PMCID: PMC9858161 DOI: 10.3390/ejihpe13010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.
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Affiliation(s)
- Benjamin F. Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Correspondence:
| | - Justin L. Maki
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - David G. Zelaya
- School of Public Health, Brown University, Providence, RI 02903, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Şeniz Warner
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Adriana Wilson
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
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Robinson AK, de Almeida-Segundo DS, Pizzinato A. Body satisfaction of lesbian and bisexual Brazilian women: Indicators of self-esteem, physical appearance perfectionism, and identity processes. J Lesbian Stud 2022; 27:89-106. [PMID: 36484730 DOI: 10.1080/10894160.2022.2150371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article examined the association between body satisfaction and sexual identification among lesbian and bisexual women, since these factors help to understand the cultural background of the objectification of female bodies in Latin cultures. Women who identify as lesbian (N = 239) and bisexual (N = 60) completed demographic data and measures of self-esteem, physical appearance perfectionism, lesbian and bisexual identity difficulties, and body satisfaction. We performed a three-stage hierarchical multiple regression to explore how variables relate to body satisfaction. The results suggest that self-esteem plays a key role, explaining 20.4% of the variance in body satisfaction. We discussed the psychosocial and cultural aspects involved in the relationship between the variables, and social and aesthetic pressures on women's bodies. This study contributes to discussions on psychosocial aspects associated with body satisfaction among Brazilian lesbian and bisexual women.
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Affiliation(s)
- Ana Karina Robinson
- Postgraduate Program in Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | | | - Adolfo Pizzinato
- Postgraduate Program in Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil
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Schmidt M, Taube CO, Heinrich T, Vocks S, Hartmann AS. Body image disturbance and associated eating disorder and body dysmorphic disorder pathology in gay and heterosexual men: A systematic analyses of cognitive, affective, behavioral und perceptual aspects. PLoS One 2022; 17:e0278558. [PMID: 36472982 PMCID: PMC9725123 DOI: 10.1371/journal.pone.0278558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study contributes to the quantitatively large, yet narrow in scope research on body image in gay men by assessing whether gay and heterosexual men systematically differ on various dimensions of body image disturbance and associated pathology, i.e., eating disorder and body dysmorphic disorder symptoms. Moreover, we examined the influence of general everyday discrimination experiences and involvement with the gay community on body image. METHOD N = 216 men (n = 112 gay men, n = 104 heterosexual men) participated in an online survey measuring the discrepancy between self-rated current and ideal body fat/ muscularity; drive for leanness, muscularity, and thinness; body satisfaction; body-related avoidance and checking; appearance fixing; overall body image disturbance; eating disorder and body dysmorphic disorder pathology; general everyday discrimination experiences; and involvement with the gay community. RESULTS Gay men showed a greater discrepancy between self-rated current and ideal body fat; higher drive for thinness, body-related avoidance, appearance fixing, overall body image disturbance, eating disorder and body dysmorphic disorder pathology; and lower body appreciation than heterosexual men (all p ≤ .05). Contrary to expectation, everyday discrimination experiences were more strongly associated with body image disturbance and eating disorder/ body dysmorphic disorder pathology in heterosexual men than in gay men (all p ≤ .05). Gay community involvement was not associated with any body image disturbance-, ED-, or BDD aspect in gay men (all p ≥ .20). DISCUSSION The results suggest greater body image disturbance in gay men than in heterosexual men regarding cognitions, emotions, behaviors, and perception as well as higher eating disorder and body dysmorphic disorder pathology. The results also suggest the dilemma of a thin, yet muscular body ideal in gay men. Surprisingly, discrimination experiences and involvement with the gay community did not explain differences in body image disturbance. Gay men may have become resilient to discrimination over time, and body ideals might differ across gay sub-communities.
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Affiliation(s)
- Michaela Schmidt
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
- * E-mail:
| | - Christoph O. Taube
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Thomas Heinrich
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Andrea S. Hartmann
- Department of Psychology, Unit of Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
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11
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Nowicki GP, Marchwinski BR, O'Flynn JL, Griffths S, Rodgers RF. Body image and associated factors among sexual minority men: A systematic review. Body Image 2022; 43:154-169. [PMID: 36150358 DOI: 10.1016/j.bodyim.2022.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.
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Affiliation(s)
- Genevieve P Nowicki
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Simmons University, Boston, USA
| | - Breana R Marchwinski
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Simmons University, Boston, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA
| | - Jennifer L O'Flynn
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Scott Griffths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France
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12
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Barnhart WR, Sun H, Lin Z, Lu C, Han X, He J. Integrating the tripartite influence, minority stress, and social comparison theories to explain body image and disordered eating in Chinese sexual minority men and women. Body Image 2022; 43:95-106. [PMID: 36095853 DOI: 10.1016/j.bodyim.2022.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
Theories of eating pathology explain body image and disordered eating in diverse populations, including sexual minority (SM) individuals. Yet, previous efforts to extend theories of eating pathology to SM individuals have mostly focused on Western populations. The present study integrated the tripartite influence, minority stress, and social comparison models to explain variance in body image and disordered eating in Chinese SM men and women. Chinese self-identified SM adults (N = 1051; n = 519 men, n = 532 women) completed an online, cross-sectional study that assessed sociocultural influences (e.g., tripartite influence), minority stress, social comparisons, drive for muscularity, and disordered eating. Two integrated models were tested for men and women using structural equation modeling. Across both populations, sociocultural influences exerted the largest direct positive effects on body image and disordered eating. In men, only downward body image comparisons were uniquely related to outcomes. In women, higher upward body image comparisons were uniquely associated with higher drive for muscularity and higher downward body image comparisons were uniquely associated with higher thinness-oriented disordered eating. Minority stressors (e.g., sexual orientation concealment, internalized homophobia) were uniquely related to outcomes in men, not women. Findings extend existing theories of body image and disordered eating to Chinese SM populations.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Hongyi Sun
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China; Institute of Epidemiology and Health Care, University College London, UK
| | - Zhicheng Lin
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Chen Lu
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Xinni Han
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China.
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13
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Ghaderi A, Welch E. Appearance and Performance-Enhancing Drugs and Supplements, Eating Disorders Symptoms, Drive for Muscularity, and Sexual Orientation in a Sample of Young Men. Nutrients 2022; 14:nu14224920. [PMID: 36432606 PMCID: PMC9695459 DOI: 10.3390/nu14224920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
In an anonymous online study (N = 824), we investigated the frequency of use of appearance and performance-enhancing drugs and supplements (APEDS) in a sample of young men (15−30 years) in Sweden, along with their self-reported eating disorder (ED) symptoms, drive for muscularity and sexual orientation. A total of 129 participants (16.1%) reported regular use of supplements (at least once a week), including one individual using anabolic steroids (0.1%), while a lifetime use of APEDS was reported by 32.3%. The overlap between those using protein supplements and creatine was large (83.6%). Some symptoms of ED (e.g., dietary restraint, objective binge eating, self-induced vomiting, and excessive exercise) significantly predicted the use of APEDS. In addition, the use of APEDS was significantly predicted by the drive for muscularity. The prediction was stronger for the behavioral component of drive for muscularity (Exponential B = 8.50, B = 2.14, SE = 0.16, p < 0.001, Negelkerke R2 = 0.517) than for its attitudinal component (Exponential B = 1.52, B = 0.42, SE = 0.06, p < 0.001, Negelkerke R2 = 0.088). A significantly larger proportion of those identifying as heterosexual reported using APEDS (34.4%) compared to those identifying themselves as homosexual (25.0%), bisexual (19.2%) or other (23.7%). Overall, our results suggest that the use of APEDS might be more related to the drive for muscularity and sexual orientation than symptoms of ED.
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Affiliation(s)
- Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
- Correspondence: ; Tel.: +46-852483248
| | - Elisabeth Welch
- Stockholm Health Care Services, Region Stockholm, Stockholm Centre for Eating Disorders, 10462 Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
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14
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Vanderkruik R, Ellison K, Kanamori M, Freeman MP, Cohen LS, Stice E. Body dissatisfaction and disordered eating in the perinatal period: an underrecognized high-risk timeframe and the opportunity to intervene. Arch Womens Ment Health 2022; 25:739-51. [PMID: 35524142 DOI: 10.1007/s00737-022-01236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/26/2022] [Indexed: 11/02/2022]
Abstract
The normal physical changes associated with pregnancy may increase the risk of body dissatisfaction, which is associated with negative mental health outcomes including depression and disordered eating. The purpose of this study was to explore body image and eating concerns among a sample of participants in pregnancy and postpartum and to assess interest and suggestions for a relevant intervention. This was a cross-sectional survey study requiring 10-15 min to complete. Individuals were eligible to participate in the study if they were pregnant or within 1 year postpartum, between the ages of 18 and 45, able to read and write in English, and provided online informed consent. The survey included measures and open-text questions to explore body image, eating behaviors, and related concerns in the perinatal period and to inform the development of an intervention. There were 161 participants, and over 50% were dissatisfied with their body image; 52% were among pregnant participants and 56.2% of postpartum participants. Approximately 80% reported that they would have appreciated the opportunity to participate in a program focused on body acceptance or expectations of body changes in pregnancy and postpartum. We identified intervention preferences as well as commonly reported themes regarding experiences of body image and eating concerns in pregnancy and postpartum. Body dissatisfaction and eating concerns are prevalent issues in pregnancy and postpartum, and our findings underscore an opportunity to tailor an intervention relevant to body image and disordered eating for the perinatal population.
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15
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Sandoval CM, Romano KA, Heron KE, Dawson CA, Sutton TG, Winstead BA, Lewis RJ. Associations between body dissatisfaction and relationship functioning among same-sex female couples: An actor-partner interdependence model. J Fam Psychol 2022; 36:780-790. [PMID: 34968096 PMCID: PMC9651090 DOI: 10.1037/fam0000945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nearly all past research about body dissatisfaction and romantic relationship factors is among heterosexual couples; little is known about these associations in sexual minority couples. The present study aimed to fill gaps in the current literature by using actor-partner interdependence models (APIMs) to examine dyadic patterns of association between body dissatisfaction and different aspects of relationship functioning among same-sex female couples. Participants were 163 same-sex female romantic dyads (326 women) between the ages of 18-35 years who completed measures of body dissatisfaction and relationship factors. Results from significance testing of actor and partner effects indicated higher levels of women's own body dissatisfaction were associated with lower levels of their own, but not their partner's, relationship satisfaction, closeness, sexual satisfaction, and intimacy/connectedness. Significance testing alone indicated that the association between one's own body dissatisfaction and their partner's relationship satisfaction was not significant. However, dyadic pattern testing identified a partner pattern for this effect, which suggests that the association between one's own body dissatisfaction and one's own relationship satisfaction is similar in magnitude and direction as that between an individuals' own body dissatisfaction and their partner's relationship satisfaction. In this study, women's own body dissatisfaction was found to be negatively associated with their own relationship functioning, which is consistent with findings of women in male-female couples. Thus, these findings highlight the important role that body dissatisfaction plays in women's relationship experiences. More research is needed to better understand potential cross-partner effects of body dissatisfaction and relationship factors in same-sex female couples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Kristin E. Heron
- Virginia Consortium Program in Clinical Psychology
- Old Dominion University
| | | | | | | | - Robin J. Lewis
- Virginia Consortium Program in Clinical Psychology
- Old Dominion University
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16
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Nagata JM, DeBenedetto AM, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Cattle CJ, Obedin-Maliver J, Lunn MR. Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men. Body Image 2022; 41:67-73. [PMID: 35228105 PMCID: PMC9997419 DOI: 10.1016/j.bodyim.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 01/12/2023]
Abstract
This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | | | - Tiffany A Brown
- Department of Psychology, Auburn University, Auburn, AL, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Lavender
- San Diego State University Research Foundation, San Diego, CA, USA; Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Matthew R Capriotti
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA; Department of Psychology, San José State University, San Jose, CA, USA
| | - Annesa Flentje
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Micah E Lubensky
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- Department of Psychology, San José State University, San Jose, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- Department of Psychology, San José State University, San Jose, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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17
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Shepherd BF, Brochu PM, Rodriguez-Seijas C. A critical examination of disparities in eating disorder symptoms by sexual orientation among US adults in the NESARC-III. Int J Eat Disord 2022; 55:790-800. [PMID: 35467039 DOI: 10.1002/eat.23717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sexual minoritized persons evidence higher prevalence of eating disorders than heterosexual persons, yet it is unclear which specific symptoms drive these disparities. Empirical evidence also documents the importance of considering subclinical eating disorder presentations, as well as potential differentiation in expression of eating disorder symptoms based on gender. The current study complements that of Kamody et al. (2020), who examined sexual orientation-based disparities in eating disorder diagnoses using a nationally representative sample of the US adult population. METHOD Using the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), we compared the prevalence of eating disorder symptoms across sexual minority status separately for men and women. RESULTS Sexual minoritized men were more likely than heterosexual men to report body mass index (BMI) < 18.5 kg/m2 (odds ratio [OR] = 1.76), thus, being screened into questions about restrictive eating. Sexual minoritized women were more likely than heterosexual women to endorse ever engaging in a binge-eating episode (OR = 2.25) and engaging in weekly binge eating for at least 3 months (OR = 1.58), thus, being screened into follow-up questions about binge eating. Sexual minoritized men were more likely than heterosexual men to fear gaining weight even when at their lowest weight (OR = 4.35) and experience a loss of control when overeating (OR = 3.13). DISCUSSION Sexual orientation-based disparities in eating disorder symptom endorsement were nuanced when stratifying the entire sample by gender. Findings expand previous research on disparities in clinical/diagnosed eating disorders, highlighting the importance of assessing symptomology beyond diagnosis, as well as the intersectional influence of sexual orientation and gender, in both research and practice.
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Affiliation(s)
- Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, USA
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18
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Bhugra D, Killaspy H, Kar A, Levin S, Chumakov E, Rogoza D, Harvey C, Bagga H, Owino-Wamari Y, Everall I, Bishop A, Javate KR, Westmore I, Ahuja A, Torales J, Rubin H, Castaldelli-Maia J, Ng R, Nakajima GA, Levounis P, Ventriglio A. IRP commission: sexual minorities and mental health: global perspectives. Int Rev Psychiatry 2022; 34:171-199. [PMID: 36151836 DOI: 10.1080/09540261.2022.2045912] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual orientation is a key determinant of the identity of human beings. It has also been seen as a social determinant of health. People whose sexual orientation is non-heterosexual or sexual minorities or sexually diverse are included in the broad umbrella term LGBT (Lesbian, Gay, Bisexual, and Transgender) which is a commonly used acronym in activism, social policy, and subsequently cultural literature. For this reason, this Commission focuses primarily on sexual orientation i.e. lesbian, gay and bisexual (LGB) groups. We have used terms non-heterosexual, sexual minorities or sexual variation interchangeably. We have not considered asexual individuals as research in the field is too limited. We are cognisant of the fact that topics relating to mental health and sexual orientation discussed in this Commission will intersect with other issues of personal, cultural and social identity, and will thus be relevant to individuals including many transgender individuals. The inclusion of mental health issues relevant to gender-diverse individuals as well as gender identity is important and deserves its own separate detailed discussion. The exact number of sexually diverse individuals in a population is often difficult to estimate but is likely to be somewhere around 5% of the population. Rates of various psychiatry disorders and suicidal ideation and acts of suicide in LGB populations are higher than general population and these have been attributed to minority stress hypothesis. Elimination of inequality in law can lead to reduction in psychiatric morbidity in these groups. However, these are all diverse groups but even within each group there is diversity and each individual has a distinct and unique experiences, upbringing, responses to their own sexual orientation, and generating varying responses from families, peers and friends as well as communities (including healthcare professionals). The mental healthcare needs of sexual minority individuals vary and these variations must be taken into account in design, development and delivery of healthcare and policies. Improving access to services will help engagement and outcomes and also reduce stigma. The commission recommends that there is no role for so-called conversion therapies and other recommendations are made for clinicians, researchers and policymakers.
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Affiliation(s)
- Dinesh Bhugra
- Emeritus Mental Health & Cultural Diversity, PO72, Centre for Affective Disorders, Institute of Psychiatry, Kings College, London, UK
| | - Helen Killaspy
- Rehabilitation Psychiatry, University College, London, UK
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Saul Levin
- Chief Executive and Medical Director, American Psychiatric Association, Washington, DC, USA
| | - Egor Chumakov
- Department of Psychiatry, St Petersburg State University, St Petersburg, Russia
| | - Daniel Rogoza
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Carol Harvey
- Department of Psychiatry, University of Melbourne and North Western Mental Health, Melbourne, Australia
| | | | | | - Ian Everall
- Institute of Psychiatry, Kings College, London, UK
| | - Amie Bishop
- OutRight Action International, Seattle, WA, USA
| | | | - Ian Westmore
- South African Society of Psychiatrists, Bloemfonten, South Africa
| | - Amir Ahuja
- Los Angeles LGBT Center, AGLP: The Association of LGBTQ Psychiatrists, Los Angeles, CA, USA
| | - Julio Torales
- Department of Psychiatry, National University of Asunción, San Lorenzo, Paraguay
| | - Howard Rubin
- Department of Psychiatry, UCSF School of Medicine, San Francisco, CA, USA
| | - Joao Castaldelli-Maia
- Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil.,Columbia University, New York, NY, USA
| | - Roger Ng
- Alpha Clinic, Central, Hong Kong, China
| | | | - Petros Levounis
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
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19
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Nagata JM, McGuire FH, Lavender JM, Brown TA, Murray SB, Greene RE, Compte EJ, Flentje A, Lubensky ME, Obedin‐Maliver J, Lunn MR. Appearance and performance-enhancing drugs and supplements, eating disorders, and muscle dysmorphia among gender minority people. Int J Eat Disord 2022; 55:678-687. [PMID: 35352378 PMCID: PMC9106876 DOI: 10.1002/eat.23708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Appearance and performance-enhancing drugs and supplements (APEDS) can be used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among gender minority people. METHOD Participants were 1653 gender minority individuals (1120 gender-expansive [defined as a broad range of gender identities that are generally situated outside of the woman-man gender binary, e.g., genderqueer, nonbinary] people, 352 transgender men, and 181 transgender women) recruited from The Population Research in Identity and Disparities for Equality Study in 2018. Regression analyses stratified by gender identity examined associations of any APEDS use with eating disorder and muscle dysmorphia symptom scores. RESULTS Lifetime APEDS use was common across groups (30.7% of gender-expansive people, 45.2% of transgender men, and 14.9% of transgender women). Protein supplements and creatine supplements were the most commonly used APEDS. Among gender-expansive people and transgender men, lifetime use of any APEDS was significantly associated with higher eating disorder scores, dietary restraint, binge eating, compelled/driven exercise, and muscle dysmorphia symptoms. Any APEDS use was additionally associated with laxative use among gender-expansive people. Among transgender women, use of any APEDS was not significantly associated with eating disorder or muscle dysmorphia symptoms. DISCUSSION APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in gender-expansive people and transgender men, thus highlighting the importance of assessing for these behaviors and symptoms among these populations, particularly in clinical settings. PUBLIC SIGNIFICANCE This study aimed to examine APEDS use among gender minority people. We found that 30.7% of gender-expansive (e.g., nonbinary) people, 45.2% of transgender men, and 14.9% of transgender women reported lifetime APEDS use, which was associated with eating disorder and muscle dysmorphia symptoms in transgender men and gender-expansive people. Clinicians should assess for these behaviors in gender minority populations.
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Affiliation(s)
- Jason M. Nagata
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - F. Hunter McGuire
- The Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Metis FoundationSan AntonioTexasUSA
| | - Tiffany A. Brown
- Department of Psychological SciencesAuburn UniversityAuburnAlabamaUSA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Emilio J. Compte
- Eating Behavior Research Center, School of PsychologyUniversidad Adolfo IbáñezSantiagoChile
- Research DepartmentComenzar de Nuevo Treatment CenterMonterreyMexico
| | - Annesa Flentje
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Alliance Health Project, Department of Psychiatry and Behavioral SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
| | - Micah E. Lubensky
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
| | - Juno Obedin‐Maliver
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
- Division of Nephrology, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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20
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Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL. A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord 2022; 55:423-454. [PMID: 35288967 PMCID: PMC8988395 DOI: 10.1002/eat.23699] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
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Affiliation(s)
- C. Blair Burnette
- Charleston Area Medical CenterCharlestonWest VirginiaUSA,Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jessica L. Luzier
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | - Chantel M. Weisenmuller
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
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21
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Soulliard ZA, Layland EK, Smith JC, Kipke MD, Bray BC. Body Image Concerns, Correlates, and Community Connection Among Black and Latinx Sexual Minority Cisgender Men and Transgender/Gender Nonconforming Young Adults. LGBT Health 2022; 9:122-130. [PMID: 34981966 PMCID: PMC8968849 DOI: 10.1089/lgbt.2021.0237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AbstractPurpose: We extended the focus on body image research beyond cisgender, White sexual minority men (SMM) by describing body image concerns among Black and Latinx SMM and transgender/gender nonconforming (TGNC) adults and by examining protective effects of community connection. Methods: From 2016 to 2020, 447 Black and Latinx SMM (94%) and TGNC (6%) individuals in Los Angeles provided data semiannually. Participant endorsement of any body image concerns was determined by five body image codes (weight, fitness, appearance, body area dissatisfaction, and general body image) applied to participants' open-ended lists of health and body concerns. Fixed effects multivariable logistic regression was performed to examine the association between gay and racial/ethnic community connection and odds of any body image concerns, accounting for multiple records per person. An interaction term between gay and racial/ethnic community connection approximated the protective effect of connection to multiple, intersecting communities. Results: The majority of participants (51%) reported a body image concern, most commonly weight concerns, at least once across three years. Body image concerns were more common among Latinx participants (χ2 = 17.79, p < 0.001) and participants experiencing food insecurity (χ2 = 4.11, p = 0.04) and unmet basic financial needs (χ2 = 10.56, p = 0.001). Gay community connection was protective against body image concerns, but only for participants who had high racial/ethnic community connection (adjusted odds ratio = 0.87, p = 0.05). Conclusion: Body image concerns were notable, especially among those with low community connection and higher socioeconomic burden. These findings suggest that building connections within SMM/TGNC and racial/ethnic communities may aid in building a support network that buffers against body image concerns.
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Affiliation(s)
- Zachary A. Soulliard
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Address correspondence to: Zachary A. Soulliard, PhD, Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT 06510, USA
| | - Eric K. Layland
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | - Bethany C. Bray
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
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22
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Abstract
The rules of fair play in sport generally prohibit the use of performance-enhancing drugs (PEDs). The World Anti-Doping Agency (WADA) oversees global antidoping regulations and testing for elite athletes participating in Olympic sports. Efforts to enforce antidoping policies are complicated by the diverse and evolving compounds and strategies employed by athletes to gain a competitive edge. Now between the uniquely proximate 2021 Tokyo and 2022 Beijing Olympic Games, we discuss WADA's efforts to prevent PED use during the modern Olympic Games. Then, we review the major PED classes with a focus on pathophysiology, complexities of antidoping testing, and relevant toxicities. Providers from diverse practice environments are likely to care for patients using PEDs for a variety of reasons and levels of sport; these providers should be aware of common PED classes and their risks.
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Affiliation(s)
- C James Watson
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Genevra L Stone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel L Overbeek
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare, Ōtawara, Japan
| | - Michele M Burns
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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23
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Nagata JM, McGuire FH, Lavender JM, Brown TA, Murray SB, Compte EJ, Cattle CJ, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR. Appearance and performance-enhancing drugs and supplements (APEDS): Lifetime use and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Eat Behav 2022; 44:101595. [PMID: 35066385 PMCID: PMC9359347 DOI: 10.1016/j.eatbeh.2022.101595] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Appearance and performance-enhancing drugs and supplements (APEDS) are used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. METHODS Participants were cisgender sexual minority people (1090 gay men, 100 bisexual plus men, 564 lesbian women, and 507 bisexual plus women) recruited from The PRIDE Study in 2018 who reported lifetime APEDS use and completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Muscle Dysmorphic Disorder Inventory (MDDI). Regression analyses stratified by gender and sexual orientation examined associations of any APEDS use with EDE-Q and MDDI scores. RESULTS Lifetime APEDS use was common across the four groups of cisgender sexual minority people (44% of gay men, 42% of bisexual plus men, 29% of lesbian women, and 30% of bisexual plus women). Protein supplements and creatine supplements were the most commonly used APEDS. Any APEDS use was associated with higher EDE-Q scores on one or more subscales in all sexual minority groups. Further, any APEDS use was associated with higher MDDI Total Scores in all groups; any APEDS use was associated with all MDDI subscale scores in cisgender gay men only. DISCUSSION APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in sexual minority men and women, thus highlighting the importance of assessing for these behaviors and symptoms among these populations in clinical settings.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA.
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130, USA.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA.
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; San Diego State University Research Foundation, 5250 Campanile Dr, San Diego, CA 92182, USA.
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA 90033, USA.
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Diagonal Las Torres 2640, Santiago, Peñalolén, Región Metropolitana, Chile; Research Department, Comenzar de Nuevo Treatment Center, Avenida Humberto Lobo 1001, Del Valle, 66220 San Pedro Garza García, N.L., Mexico.
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA.
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way San Francisco, CA 94143, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1930 Market Street, San Francisco, CA 94102, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
| | - Micah E Lubensky
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way San Francisco, CA 94143, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305-5405, USA.
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305-5405, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
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24
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Shepherd BF, Brochu PM, Stripling AM. Hidden grief is complicated: identity concealment as a minority stressor and relational-cultural barrier among bereaved sexual and gender minoritized elders. Psychology & Sexuality 2021. [DOI: 10.1080/19419899.2021.1970618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Benjamin F. Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
| | - Ashley M. Stripling
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
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25
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Convertino AD, Helm JL, Pennesi JL, Gonzales M, Blashill AJ. Integrating minority stress theory and the tripartite influence model: A model of eating disordered behavior in sexual minority young adults. Appetite 2021; 163:105204. [PMID: 33741450 DOI: 10.1016/j.appet.2021.105204] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/15/2020] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
Eating disorders are serious mental illnesses associated with high mortality rates and health complications. Prior research has found increased rates of eating pathology in sexual minority (SM; e.g., lesbian, gay, bisexual) individuals compared to sexual majority (i.e., heterosexual) individuals. Two prominent models have potential to explain these differences: the tripartite influence model and minority stress theory. While both models separately have promise for explaining the pathway of eating disordered behavior in SM individuals, research has indicated that both models have unexplained variance. Therefore, a comprehensive, integrative model could further explain unique variance. 479 men and 483 women between 18 and 30 years old were recruited through Qualtrics; all participants endorsed attraction to same-gender partners. Two models were estimated by gender using structural equation modeling. For men and women, community involvement accelerated the positive association of heterosexist discrimination with internalized homophobia. Minority stressors were associated with dissatisfaction and muscularity behavior, indicating the importance of incorporating minority stress. For women, community involvement accelerated both the association of pressures with muscularity internalization and the association of muscularity-based dissatisfaction with muscle building behaviors. If confirmed by prospective studies, this model could help refine prevention and intervention efforts with this vulnerable population.
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Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Jonathan L Helm
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States; Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - Jamie-Lee Pennesi
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - Manuel Gonzales
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States; Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States.
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