Anorexia and Sexual Orientation

A California psychotherapist recently emailed me about an anorexic client who was a lesbian. “Once she accepted that she was gay, her anorexia was no longer an issue,” he wrote. The clinician then asked me whether there was any research on anorexia nervosa and sexual orientation.

The answer is yes, but the association is complex. Recent studies indicate that while male homosexuals have a greater risk of developing anorexia than their “straight” counterparts, lesbian populations show less incidence of the illness than heterosexual women.

Eating disorders specialist Barton J. Blinder cites research by Herzog indicating that male anorexic patients experience sexual isolation, sexual inactivity, and conflicted homosexuality1. Herzog hypothesized that cultural pressure exerted by the gay community on homosexual men to be thin and attractive increases their risk for eating disorders2. While gay men represent three to five percent of the total male population3, they account for 20 percent of eating disorders among men4.

According to an article appearing on Medscape, a study of 135 eating disordered men conducted by psychiatrist Daniel J. Carlat, M.D. at Anna Jacques Hospital in Newburyport, Massachusetts found that 46 percent had bulimia, and 42 percent of the bulimic men were either homosexual or bisexual5. Thirty men (22 percent) had anorexia, and of these, 58 percent were asexual, which was defined by the researchers as lacking all sexual interest for one year prior to the study6. The researchers are quoted in the article as follows: “Homosexuality can be seen as a risk factor which puts males in a subcultural system that places the same premium on appearance in men as the larger culture places on women.”7.

However, the article also reports the observation of New York psychologist and eating disorders specialist Janet David, Ph.D. that the amount of research on this subject is small and should, therefore, be cautiously interpreted.

In contrast to male homosexuality, there is evidence that lesbianism may be a “protective factor” against developing an eating disorder8. Research by Siever indicates that pressure for thinness exerted by members of one’s community, from greatest to least, is as follows: heterosexual females, gay males, lesbian females, and heterosexual males9. This theory, however, remains controversial10.

Nothing in this article is meant to suggest that anyone should consider changing his or her sexual orientation. Gregory M. Herek, Ph.D., of the University of California at Davis, provides an excellent overview of this subject. Herek notes that the American Psychological Association has condemned the practice of “reparative therapy” touted by religious groups and others as a method of promoting heterosexuality in homosexuals. He describes the methodological and ethical problems with studies purporting to demonstrate the success of this technique.

Current research indicates that approximately 90 percent of anorexics are female and ten percent are male 11, but there is evidence that diagnostic criteria for anorexia nervosa are gender-biased. For example, one standard requirement for making a diagnosis of anorexia in women is three months of amenorrhea (absence of a menstrual period), but there is no equivalent criterion for men12. Research indicates that amenorrhea is not an important factor in determining the severity, or even existence, of anorexia in women13.

While current diagnostic tools favor making a diagnosis of anorexia in females, research suggests that the incidence of eating disorders is increasing in both genders14. The reason for the reported rise is probably due to both a genuine increase and better detection methods.