Is Abuse in Childhood a Risk Factor for Eating Disorders Among Gay and Bisexual Men?

Results of prior studies have suggested that the male gay community stresses physical appearance, and pressure to conform to these physical ideals then increases the risk of developing an eating disorder. According to Drs. Matthew B. Feldman and Ilan H. Meyer of the NIMH, Bethesda, and the Mailman School of Public Health, New York City, a high prevalence of childhood abuse among gay and bisexual men may be another important risk factor for eating disorders.

Data from a community-based study

The authors designed a study to evaluate the association, if any, between childhood abuse and development of eating disorders among 193 white, African-American, and Latino gay and bisexual men (Int J Eat Disord 2007;40:418). DSM-IV diagnoses of anorexia nervosa, bulimia nervosa, and binge eating disorder were assessed with the Composite International Diagnostic Interview (CIDI) (Arch Gen Psychiatry 2005; 62:593).The CIDI was developed to improve upon the Diagnostic and Statistical Manual by developing structured interviews for mental disorders and a process for establishing definite diagnoses. During the interview, respondents are asked questions about symptoms of psychiatric disorders, and clinicians have a framework for establishing a positive diagnosis. In this study, respondents were sampled by direct solicitation by interviewers in community settings, including bookstores and cafes, social groups and parks, and through referrals.

Diagnoses of eating disorders were made using the computer-assisted personal interview version 19 of the World Mental Health-CIDI. The authors’ study included a subsample of the larger group, 193 gay and bisexual males (mean age: 33 years). In this group, 85% were identified as gay and 14% as bisexual. Twenty-three percent of the gay and bisexual men had a high school diploma or less education. Overall, the African-American and Latino respondents had a lower socioeconomic status than the white men, as indicated by less education and lower income.

A history of childhood sexual and physical abuse was assessed following the usual procedures of the Life Events Questionnaire. The respondents were first asked whether they had experienced any of a list of events, including childhood sexual and physical abuse. If so, the interviewer wrote an event narrative.

One-third of the men had been abused

Of the gay and bisexual men in this sample, 33% had a history of physical abuse in childhood (defined as an injury that took them to the doctor or hospital), and 34% had a history of childhood sexual abuse. Analyses showed that bisexual men had a higher prevalence of childhood sexual abuse than did men who identified themselves as gay. African-American and Latino men had a higher prevalence of childhood sexual abuse than did white men, and men with a high school education or less had a higher prevalence of sexual abuse during childhood than did men with more education. The numbers were not affected by age or by net worth. Physical abuse during childhood was not related to any of the eating disorders.

When compared with men without a history of childhood sexual abuse, men with such a history were more likely to have developed subclinical bulimia and both current and lifetime subclinical eating disorders. Risk for full-syndrome eating disorders followed the same pattern but did not reach statistical significance. Although childhood sexual abuse was associated with eating disorders, substance abuse or major depressive disorder were not. Neither was found to be significant mediators of the relationship between abuse and eating disorders. According to the authors, future research may help explain why sexual abuse, but not physical abuse, during childhood increases the risk for an eating disorder among gay and bisexual men.