Eating Disorders – National Eating Disorders Association

by Chase Bannister

CW: discussion of eating disorders, disordered eating, and body shaming

So, is it nature or is it nurture?

nedaIf you’re within earshot of the ivory tower, chances are that two things are true—first, reading the query above quickened your heartbeat just a touch, and, secondly, you’ve encountered this philosophical inquiry more than once in your academic life, either by some Psych 101 syllabus or (dare I say more importantly) in the context of those nonpareil  ‘meta’ conversations with friends, held in the watches of the night.

As both a psychotherapist and an advanced miscreant prone to innocuous schadenfreude, I rather enjoy posing such questions to a couple of unsuspecting professorial types, each of whom having declared some unwavering opinion—just to see whose eyelids will start twitching first.  We all have vices.  Don’t judge.

I’ve yet to see anyone get punched in the throat—categorically good from my pacifist lens—but I’ve not yet paired an epigenetics scholar with a sociologist.  And seriously, y’all, beware the sociologists; they can get pretty scrappy.  I’m just sayin’.

When the “it” in the “is it nature or is it nurture?” query is antecedent of sexual orientation, gender expression, or rights thereof, I’ve found that many LGBTQ folks and allies are particularly rockstar at mediating intractable camps. While working as a clinician at Duke University’s Counseling & Psychological Services, time and time again I witnessed courageously vulnerable LGBTQ persons help others (both within and without the LGBTQ community) wade through complex issues of personal identity, gender fluidity, and the veiled violence of an overwhelmingly heteronormative world.   Those painfully beautiful moments still my heart, even now.

All the while, inside the (admittedly therapist-y decorated) offices shared amongst my colleagues, a specific nature/nurture struggle from within the LGBTQ community emerged as refrain – food, weight, body shape, appearance, size, and shame.  Eating disorders and disordered eating were consuming the lives of LGBTQ students—physically, mentally, and emotionally.

Eating disorders are the most lethal of all mental illnesses, and affect more than 25 million people in the United States.  To be redundant because it’s important, these illnesses—Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder—have taken the lives of too many wonderful young people, and continue so to do, giving little sign of abatement.

Many colleges and universities have been aware of the onslaught of eating disorders for some time, and have been doing what they can in the context of an impoverished research environment for eating disorders.  Of course, in the absence of adequate funding for sufficient research, common lore reigns.

With myth as prevailing truth, eating disorders were (and often still are) imprudently narrated as illnesses as disorders of will, disorders of choice, and disorders of the affluent straight white girl.

Oh, and before impassioned typing gets the better of me, I should probably tell you that I’m credentialed as a Certified Eating Disorder Specialist (CEDS), having spent the last nine years resolutely and unapologetically fixated on best-practice care for persons with eating disorders, and am co-founder of Veritas Collaborative, a specialty behavioral health hospital for young people with eating disorders.

Collaborative efforts in the academic and clinical practice communities point to an alarming reality—our societal failure to acknowledge the enormity of eating disorders within the LGBTQ community.  Yep, I meant it to sound bold like that.

·      Compared to straight males, gay males are significantly more likely to restrict food, purge by vomiting or laxatives, compulsively exercise, and take diet pills to control weight.

·      Approximately 6% of males identify as gay in the US; yet gay males represent 42% of males with eating disorders.

·      Gay males appear to be at particular risk due to intra-community pressures to be muscular and thin at the same time.

·      Loneliness is an understudied and significant risk factor for gay males; those not in a (self-described) significant romantic relationship appear to engage in dramatically more—and more severe—instances of eating disorder behaviors than those in relationships.

·      Lesbian women were once considered “protected” from eating disorders because of the community’s perceived rejection of the feminine norm, yet now we know that Lesbian women are just as likely to have an eating disorder as straight women.

·      Lesbian women with body image distortion, disordered eating, and/or eating disorders are “doubly isolated within the lesbian community. And isolation perpetuates the problem.” [Naomi Tucker]

·      Trans* persons report significant body dissatisfaction along with severe dieting, fasting, and purging behaviors.

·      Only 35% of medical curricula include any information on Trans* related endocrine/hormonal/medical issues related to transitioning.

·      LGBTQ persons are at higher risk for depression, anxiety, and substance abuse disorders than straight persons (co-morbid risk factors for eating disorders)

·      LGBTQ persons people are 2 ½ times more likely than their heterosexual peers to have had a mood, anxiety, or substance abuse disorder in their lifetime (more co-morbid risk factors for eating disorders)

Moreover, we know that eating disorders—complex disorders that live at the intersection of nature and nurture and the intersection of physical illness and mental illness—can start out as ways to cope with the stress, stigma, and shame heaped upon them (a concept called “minority stress”).  LGBTQ persons might engage disordered eating behaviors as:

•       A way to manage difficult and ambivalent feelings about being LGBTQ and/or being out

•       A way to mitigate and control feelings about one’s gender or gender expression

•       An identity to hold onto while LGBTQ identities may yet be amorphous, i.e. I am my eating disorder

•       A response to trauma, in whatever form or forms that might take

•       A way of coping with the anxiety around the body-as-currency or body-as-value

•       A means of attaining a masculine or feminine ideal or

•       A way of coping with societal denigration of female masculinity.

It’s important to remember here that we believe eating disorders have a nature/nurture component to them, too.  Clinically, we understand eating disorders as remarkably complex, biogenetically-mediated mental illnesses.   That is to say, some persons may be genetically hard-wired for an eating disorder illness; absent purging or restricting or compulsively exercising, the illness might remain practically dormant, and the person may never experience the torment of an eating disorder.

All this theory is truly important to the LGBTQ community.  What might seem like an inconsequential behavior—say, restricting foods or food groups—may inadvertently trigger a long-term struggle with an eating disorder.

A hopeless optimist, I believe we have a chance to do things differently—a chance to potentially prevent our peers from having to experience this kind of pain.

And it starts with us.  Whether we’re in the therapy room, the classroom, the cafeteria, the library, or hanging out at the corner coffee shop—we can be mindful of how we talk about our bodies, and how we talk about other people’s bodies.  Given all the crap (a clinical word) LGBTQ folks have to face during high school, college, and young adulthood, the absolute last thing they need is for their own community to be participating in the criticizing, critiquing, and shaming of bodies.

It’s awesome to witness the swift progression of LGBTQ rights before our very eyes.  Yet there’s much left to be done – and so many people still left in the shadows.  Not-so-shockingly, researchers found that when LGBTQ young people feel accepted by their families, they were much more likely to believe they would have a good life—and that they would have a happy, productive adulthood.
Want a protective factor from an eating disorder for an LGBTQ person?  Help them know—as Mister Rogers did for me as a child—that they are special, that there’s no one else in the whole wide world like them, that they enrich our lives by their just being themselves, that their feelings are mentionable and manageable, and that they are wonderful and lovable just the way they are.

Chase Bannister, MDIV, MSW, LCSW, CEDS
Vice President & Chief Clinical Officer,
Veritas Collaborative

Veritas Collaborative is a Specialty Behavioral Health Hospital for Young People & Center of Excellence for the Treatment of Eating Disorders, located In Durham, North Carolina.

To learn more about the National Eating Disorders Association (NEDA) and to view the Eating Disorders in the LGBTQ Community NEDA webinar, please visit www.nationaleatingdisorders.org.

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