I recently had a fascinating conversation with Zoltan, one of our specialists in eating disorder treatment as well as sex therapy.
Here are some excerpts:
How are eating disorders different in the LGBTQ+ community compared to straight and cisgender people?
Significant differences exist in this area. Gay men are affected by eating disorders considerably more than straight men, with adolescent gay men encountering the greatest challenges. Research indicates that over 50% of adolescent gay men have received an eating disorder diagnosis at some point in their lives. That is quite a striking statistic.
Many healthcare professionals are mindful of terms such as the “thin ideal” when evaluating their patients’ relationships with food. However, with gay men who have eating disorders, it is interesting to note that one might more frequently hear terms like “shredded” or “ripped.” The discipline of psychology, along with our culture, still tends to exhibit a bias regarding eating disorders and genders. Addressing this bias with appropriate language can reveal a more accurate picture.
Why do eating disorders develop? Is there a genetic aspect to this, or is it related to trauma and the minority stress of being queer?
There are biological, social, and behavioral aspects to consider. It is a complex interaction of these elements that contributes to the development of eating disorders.
We do know that eating disorders have a strong genetic link, and individuals who have a family member with the disorder are more predisposed to developing it in themselves.
Certain personality patterns, such as perfectionism, frequently emerge in those affected and this also may be linked to genetic factors. It’s interesting to note that perfectionistic tendencies can serve as a motivating factor in behind bulimic behaviors, particularly when a perceived loss of control or impulsive eating is followed by a purge episode.
Perfectionism can serve to manage anxiety. From my observations in the gay community, it seems individuals often focus on aspects they can control, driven by the fear of what they cannot. Food and our bodies are two of those controllable elements.
We are beginning to understand that eating disorders are not solely psychiatric conditions, which is quite encouraging as it helps to reduce the stigma surrounding them.
Why is this work so important to you?
As a gay man, I have navigated my desire to belong, and I find it intriguing how much appearance influences our culture.
Many of my clients express that they feel invisible unless they possess a six-pack. The images on dating apps and social media can be overwhelming, leading some to question their self-worth and identity if they do not conform to this societal ideal.
In our culture, confidence is often linked to a specific body type, and many of us are striving to enhance our confidence.
On a positive note, more recently, our gay culture is doing a commendable job of embracing various body shapes and types. Unlike heterosexual culture, where the thin ideal, especially among women, prevails, our community tends to celebrate a broader range of body types, including bears.
Where do you typically start when treating eating disorders?
One very important aspect of my work is to support my clients in creating a recovery identity. I think of this as an authentic sense of self regarding the individual’s relationship with food and their body, and it is based on multiple factors.
Part of it is their relationship with food and their body before the eating disorder started. Comprehending the connection individuals had with food and the celebrations associated with it can be enlightening. We also uncover the type of relationship they aspire to have with food and how they wish to feel in its presence. This process enables us to commit to envisioning a relationship with our bodies that aligns with our personal values.
The work also involves examining our environment, particularly the diet culture that is pervasive and unavoidable. Comments about our appearance or eating habits are unfortunately part of our reality, even if we do not consent to them.
With many of my clients, we focus on making behavioral changes. Exposure to food items that they would typically avoid or incorporating an exercise routine that is different from their rigid exercise schedule is part of the treatment. Alongside these changes, we engage in in-depth conversations about culture, including the different ways we are exposed to unrealistic body ideals. The modifications in behavior and the discussions together contribute to an enhanced sense of self concerning the relationship with food and the body.
Shame must play a role in eating disorders, yes?
Shame is perhaps one of the most painful and uncomfortable feelings to tolerate. When people are feeling shame, they don’t just think, “I have done something wrong;” shame feels like “I am wrong” or “I am unlovable” or even “I am broken.” Feeling shame results in a sense of isolation and feeling that the individual is not worthy of connecting with others.
My patients often tell me that the feeling of shame is a large driver of their eating disorder behaviors. Then, they feel shame again after engaging in the eating disorder behaviors. One positive aspect of treatment is that many clients finally conquer this shame cycle and discover a renewed sense of self outside of their eating disorder. This painful cycle can be halted, but it can be challenging to navigate and calls for a trusting in the process of therapy, courage to step into the unknown, and a willingness to experience emotional pain in order to discover one’s recovery identity.
I feel honored that I can support many with this process.
I feel fortunate to work in this field. My personal experiences with body image concerns and unhealthy eating practices enable me to genuinely help my clients feel less alone. It’s also encouraging that recently, gay male celebrities are coming out about their eating disorders. Elton John and Olly Alexander have acknowledged their own struggles, which may inspire many to seek support.
What about other queer communities? Do we have any information about the trans or non-binary community?
Certainly, the transgender community is profoundly impacted by this issue. I have worked with many transgender individuals, particularly concerning body image issues related to fat distribution and gender presentation, which can contribute to eating disorders.
Often, when individuals transition to the gender opposite of what was assigned to them, they identify an ideal body image based on cultural standards, leading to considerable dissatisfaction with their own bodies. This can result in depression, anxiety, and potentially an eating disorder.
You specialize in eating disorders and you also specialize in sex therapy. Is there a connection for you?
Yeah, so much of a connection. I always like to say that I work with the two body functions—sex and eating—the very two that are most influenced by cultural norms.
If you hate your body, you’re not going to experience pleasure in that body. Medically, if you are malnourished, your sex drive may be diminished. If you’re focusing on those six packs, and you have a single digit body fat percentage, your brain might not be well nourished and is very likely not going to allow you to have that “fully present” sexual experience that you deserve. The body and the mind are intricately intertwined. You cannot treat one without the other in the field of eating disorders and sex therapy.
We often view sex and eating as means to satisfy our primary needs, rather than fully embracing the sensations and experiences they offer. There is a tendency to overlook joy and pleasure. Instead, we seek ways to conform to mainstream culture’s expectations, which can create a false sense of connection with others. Embracing our unique beauty can lead to genuine joy, with eating and sex.
