"Eating disorders are the most lethal of all mental illnesses and LGBTQ persons are at a remarkably high risk for these disorders and no one is talking about it," said Chase Bannister.
Bannister is a licensed clinical social worker in North Carolina and a certified eating disorder specialist by the International Association of Eating Disorders Professionals.
He is also vice president and chief clinical officer at Veritas Collaborative, a specialty behavioral health hospital for young people and an eating disorder treatment center.
He recently gave a presentation on eating disorders within the LGBTQ community, "Eating Disorders in the LGBTQ Community," as part of National Eating Disorder Awareness Week.
He said that the stereotype of someone with an eating disorder is affluent, straight, white females, but in reality eating disorders do not discriminate.
In fact, according to the National Eating Disorder Association, 10 million men are affected by eating disorders during their lifetime, which means that approximately one in three men will be affected.
Gay men are particularly at risk of developing an eating disorder.
"Gay males make up approximately 6 percent of all males in the United States, yet up to about 42 percent of males who identify as having an eating disorder are gay males," Bannister said.
He pointed to a concept called paradoxical thinness and said that both gay and straight men are affected by it.
"[It is] this drive to be muscular and toned at the same time of being remarkably thin," he explained. "It appears that gay males do trend more toward a thin ideal then a muscular ideal, but at the same time its largely similar between straight males and gay males regarding body image."
Some of the experiences that put gay men at a greater risk of developing an eating disorder include issues around coming out, experience of violence, and discrimination or bullying.
But greater acceptance isn't likely to help decrease eating disorders within the gay community. That's because greater participation within the gay community is a risk factor as well, according to Bannister.
"Being a part of gay community activities actually increases body image awareness, body image distress and eating disorder patterns," he said.
Like their female counterparts, Bannister said that gay men are often objectified and deconstructed in such a way that places the greatest value on the way their bodies look.
"Gay males have been sold a false promise by the world around them that if they will deconstruct their body and conform to this unattainable ideal then they will be loved," he said.
William Farrand, of the Center on Halsted's mental-health department, agreed, saying the media impact on the LGBT community and specifically on gay men has created an ideal that is nearly impossible to achieve.
"What is held up as the person who has it all is generally someone with chiseled abs and big biceps, and that may be what a lot of people are taking away as the only thing that anyone values about them," Farrand said.
Bannister said that lesbians are also uniquely affected by eating disorders, much more so than what was originally thought.
"It's been a societal convention that lesbian women are protected from eating disorders or have been protected from eating disorders as a matter of course," he said. "That is, they've been a part of a community that has philosophically rejected any unilateral concept of femininity, of feminine norm, or beauty, or a thin ideal attributed to women.
"What we know now that we didn't a few years ago is that lesbian and bisexual women are just as likely to present with significant eating disorders and eating disorder behaviors as straight women."
Bannister said that because of the previously held belief that lesbian women weren't affected by eating disorders very little meaningful research has been done that is focused on the lesbian community.
Researchers have largely ignored the trans community as well.
"There is not nearly enough information nor research on the trans community," he said.
However, he is somewhat optimistic that the trans community will be included more in future eating disorder studies. He noted that the International Journal of Eating Disorders most recent issue included an article on transsexuals and eating disorders.
But overall, there is a lot more research needed that focuses on all segments of the LGBTQ community.
Currently, Farrand said that there aren't any programs offered through the Center on Halsted that are specifically aimed at eating disorders, and part of that is the lack of information that is out there.
"We direct people more to groups or services that are focused on building self-esteem or wellness," he said. "It is definitely something that I think is worth us looking at."
Bannister said that one of the reasons LGBTQ persons are uniquely affected is because of a concept known as minority stress, which has to do with the societal pressure, stigma, and shame that is put on a community against its will. In the case of the LGBT community minority stress can lead to internalizing homophobia and can hasten the onset of mental illness.
Additionally, many people don't understand how eating disorders work.
"Remember that what might start an eating disorder illness and what might maintain that illness are likely two separate things," he said.
"While an LGBTQ person might begin engaging in these behaviors [restricting food intake, compulsive exercise, or binging and purging] as a way of emotionally coping, what may actually end up happening is that they will have triggered a disease state which is not a disorder of will or choice, and it is akin to having awoken a sleeping dragon in the brain and now that dragon is breathing fire and it is very heard to put back to sleep," he said.
Eating disorders remain a growing problem across the board in the United States.
"We have really created a perfect storm for making sure eating disorders stay around for a very long time," Bannister said.
To raise awareness about who is affected by eating disorders, the National Eating Disorder Association is holding its 27th annual National Eating Disorders Awareness Week Feb. 23-March 1, with the theme "I had no idea."
"What you don't know can hurt you … or someone you love," said Lynn Grefe, president and CEO of NEDA. "It is time to get the dialogue going in communities across the country and to educate ourselves to recognize the signs of an eating disorder, which are life-threatening illnesses. But there is hope and there is help, particularly with early intervention."
To find out more, visit www.NEDAwareness.org .
