Article Critique: Childhood Abuse and Eating Disorders in Gay and Bisexual Men By Dr. Matthew Feldman and Dr. Ilan Meyer

Developmental Psychology Honors Professor Karen Spikes Justin Alves March 29, 2008

I.

Goal of the Study The goal of the study was to determine the association between a high prevalence of eating disorders in gay and bisexual men. The study especially wanted to examine how it was not necessarily the childhood abuse that led to the disordered, but the depression and substance abuse that many gay or bisexual men experience as a result of abuse in their childhood. The study aims not to directly correlate childhood abuse and eating disorders in gay and bisexual men, but rather to examine how childhood abuse which leads to depression and substance abuse leads to eating disorders in gay and bisexual men.

II.

Formulation of the Problem The problem was formulated by examining previous research done on eating disorders in adult gay and bisexual men. Drs. Feldman and Meyer examined the very little research done on the subject of eating disorders in men and learned that a higher percentage of gay and bisexual men experienced eating disorders in young and middle adulthood. Feldman and Meyer both assumed that this higher percentage was due to the fact that gay and bisexual men were more likely to experience childhood abuse while growing up. Feldman and Meyer then looked at research completed by Drs. Mitchell and Mazzeo that correlated childhood abuse and eating disorders in adults by the depression that can set in during adulthood due to childhood abuse. Feldman and Meyer than suspected that the reason for the higher proportion of gay and bisexual men with disordered eating was not due directly to childhood abuse but to the depression they experienced and their lack of coping mechanisms.

Drs. Feldman and Meyer felt strongly that a lack of coping mechanisms for gay and bisexual men led many to turn to their eating habits as a coping mechanism. Drs. Feldman and Meyer proposed that because of the nature of being gay or bisexual and suffering from childhood physical or sexual abuse led to many psychological issues including: dissociation, depression, anxiety, general distress, substance abuse, and alexithymia (an inability to talk about feelings or emotions). Drs. Feldman and Meyer then decided to test the population to determine if their findings could be supported by actual research. Would childhood abuse in gay and bisexual men correlate an eating disorder by way of depression or substance abuse? III. Hypothesis of the Study Drs. Feldman and Meyer assumed that they would find a correlation between childhood abuse and eating disorders. However, what made these researchers’ hypothesis interesting was they did not directly correlate childhood abuse and eating disorders, but rather said childhood abuse would lead to adult disordered eating by way of depression and substance abuse. IV. Research Design The study was conducted mainly using different types of both handwritten and computerized surveys. The researchers began by canvassing different areas and venues of New York City to get participants for their study. The venues were chosen to gain a variable perspective from all sorts of different cultures, ethnicities, political affiliations and sexual representation within the gay and bisexual domain. The study did not choose any venues that would “over- or under- represent people receiving

support for mental health problems or significant life events.” In other words, the researchers attempted to get people who would not for any other specific reason be predisposed to having an eating disorder or a history of depression or substance abuse. V. Data Collection The participants who were gay and bisexual men were actually a subsample of 193 people from the entire study. The researchers did not focus their recruitment efforts in particularly gay or bisexual neighborhoods to ensure that they got a representative sample of the gay and bisexual population. An initial 55 minute interview was conducted to determine basic information about the participants including: sexual orientation, gender, race/ethnicity, and socioeconomic status. The second interview used computerized technology to ask the subsample of participants different questions about disordered eating habits, substance abuse and depression, a history of childhood abuse, and other sociodemographic factors. All of the computerized surveys were done in accordance with the WHM-CIDI National Comorbidity Study and the DSM IV. Additionally, a history of childhood physical abuse and childhood sexual abuse were assessed using a Life Events Questionnaire. Finally, researchers put the participants into two separate groups based on age. The first, young adults were ages 18-33 and the second group was participants aged 33-59 years old. These two separate groups were then further subdivided based on Education and Net worth. The age group from 33-59 was far more prevalent and had

more participants than the other group, meaning the study focuses more on those gay and bisexual men in middle adulthood than those in young adulthood. VI. Data Analysis The data collected in the different surveys was studied using a χ2 analysis to assess the demographic group difference in the prevalence of a history of childhood abuse. Analysis for the correlation between childhood abuse and eating disorders was examined using regression models, which worked correctly except in the case of full blown anorexia. To examine the role depression and substance abuse played in accommodating the eating disorders in gay and bisexual men with a history of childhood abuse Baron and Kenny’s procedure was used along with SPSS statistical analysis software. VII. Interpretation of the Results The research conducted by Drs. Feldman and Meyer yielded some interesting and somewhat unexpected results. Firstly, Feldman and Meyer found like almost every study that had been conducted prior to them that childhood abuse did in fact increase the risk of adult gay and bisexual men developing eating disorders in young and middle adulthood. The analysis of the results also revealed that bisexual men had a higher prevalence of sexual abuse than gay men. That African Americans and Latinos had a higher prevalence of sexual abuse than Caucasians. Also, the study discovered that gay and bisexual men with a high school diploma or less had a higher prevalence of sexual abuse than did those with a higher education level. However, the study did not

prove that there was any more sexual abuse in either generation or in relation to general net worth. However, what was perhaps most important about this study is the fact that the researcher found no correlation between childhood sexual abuse and the putative mediators. Therefore, since no correlation could be found between childhood sexual abuse and depression or substance abuse, the researchers could not say that those mediators were the cause for the increased proportion of gay and bisexual men with eating disorders. Thus, only part of the researchers’ hypothesis was correct. VIII. External Validity The research conducted by Drs. Feldman and Meyer was highly specific to one subgroup of an entire population. It is extremely difficult to argue that the researchers findings regarding a correlation between childhood abuse and adult eating disorders is incorrect because the researchers got a very diverse population of people and then chose from the entire population a sub group that they could use for their research. Additionally, the researchers did not fill their study with any specific type of person from the gay or bisexual community they discovered by avoiding any place where there would be an over-representation of people with substance abuse problems or previously documented psychological issues from extreme or unexpected life events, such as AIDS shelters or abuse centers. Therefore, the part of the research that indicates that childhood abuse is positively correlated with adult eating disorders is highly valid for the population of gay and bisexual men they studied. Unfortunately, the part of the researchers’ findings that was new in the study of gay and bisexual men with eating disorders is poorly validated. Therefore, I would

rate the study on the whole as being poor. This is because of the small population size that the researchers studied. The researchers made conclusions about an entire group of people based on 193 people ranging from the ages of 18-59, which if evenly distributed means about 5 people per age. Therefore, while the researchers did confirm the results of past studies in their own they did not have a large enough population size to draw any broad-spectrum conclusions. Additionally, the researchers did not study the eating disorders of gay or bisexual women to determine if the reasons for the higher risk happened to be comorbid with the depression or abuse that many of the homosexual or bisexual orientation have experienced throughout their lifetimes. IX. Recommendations The topic the researchers chose to explore was interesting and gives a new perspective to the study of eating disorders in adult gay and bisexual men. I think the most important recommendation for further research would be to increase the number of gay and bisexual men that were studied while keeping the same amount of diversity in the study, including: age, socioeconomic status, education level, and ethnicity and culture. The researchers also should look into the other psychological issues they discussed and their role as mediator for disordered eating. I feel that the researchers should have added further questions to the survey not only directed at depression and substance abuse but also to address the other possible mediators like alexithymia, anxiety, general distress, and dissociation. Possibly, the correlation that the researchers thought existed between childhood abuse and adult eating disorders with

depression and substance abuse as mediators could be seen with another psychological issue acting as the mediator. X. Reflection The topic of the article is related highly to different aspects of today’s U.S. society. As the U.S. becomes more and more focused on eating disorders in young teenage women it is important to remember that they are not the only ones suffering from this psychological disorder. Also, the idea that childhood abuse is becoming more and more strongly coordinated in both women and now gay and bisexual men it implies eating disorders are much more heavily laden with the need for control than a need to be skinny. The article was incorporated slightly in lectures in class when we discussed adolescents and eating disorders. I have been fascinated by the intricate goings on in people’s minds who suffer from eating disorders and felt it would be interesting to see how disordered eating in adulthood occurred. The article has also been incorporated into lectures on middle adulthood, because the childhood abuse in some sense has prevented the men that were studied from truly reaching in Erikson’s words what is identity and therefore they are unable to reach generativity because they lack the necessary skills.
      The  article  critique  I  submitted  is  the  first  article  I  analyzed  in  my  Honors  Developmental   Psychology  class  my  second  year  at  Northeastern  University.  It  is  amazing  how  two  years  later  this   specific  article  actually  affected  the  way  I  worked  in  a  clinical  setting.  While  at  a  clinic  I  was  caring  for  a   24  year  old  patient  who  was  gay  and  I  was  able  to  ascertain,  after  he  divulged  his  history  of  childhood   abuse,  that  he  had  a  current  eating  disorder,  despite  the  fact  that  he  had  no  physical  symptoms.  Taking  

the  time  in  developmental  psychology  to  pour  over  different  research  articles  and  truly  absorb  some  of   the  new  information  they  provided  me  with  changed  the  way  I  took  care  of  patients!  I  can  honestly  say   that  I  gained  more  than  just  knowledge  from  one  article  that  helped  me  with  a  patient  down  the  line   because  I  truly  gained  a  vital  skill  during  developmental  psychology.   During  my  time  in  the  Honors  section  of  Developmental  Psychology  I  trudged  through  tons  of   academic  papers  to  practice  teasing  apart  the  intricacies  of  a  study  and  whether  or  not  it  was  proof  of   anything  substantial.  The  concept  of  taking  a  piece  of  new  research  and  teasing  out  the  main  points  and   determining  what,  if  anything,  did  the  paper  or  the  study  prove    became  one  of  the  most  useful  tools  I   gained  in  my  undergraduate  career.  Throughout  my  time  in  the  nursing  program  I  was  told  that  being   up-­‐  to-­‐date  in  my  clinical  practice  was  essential  if  I  wanted  to  be  a  good  nurse.  The  easiest  and  best  way   for  someone  to  do  that  is  by  actively  reading  and  digesting  the  thousands  of  nursing  research  articles   that  come  out  on  a  regular  basis  in  journals  all  over  the  country.  While  I  don’t  have  time  to  go  through   the  thousands  of  new  articles  that  are  published  every  month  I  do  have  the  ability  to  read  articles  that   are  pertinent  to  my  area  of  clinical  practice  and  determine  how  best  to  continue  providing  care  to  my   patients.