Sexual orientation and eating psychopathology: the role of masculinity and femininity

OBJECTIVE: Previous research suggests that eating disorders are related to homosexuality in men, although links with female sexual orientation are less clear. Appearance factors have generally been implicated in this relationship. However, previous studies have failed to consider the role of femininity, even though evidence suggests that this is a more critical factor than sexual preference. The aim of this study was to consider the relationship between gender-role orientation and eating psychopathology in nonclinical men and women of different sexual orientations. METHOD: One hundred university students (40 homosexual; 60 heterosexual) completed the Bem Sex Role Inventory and the Eating Attitudes Test. RESULTS: For the group as a whole, there were links between femininity and high levels of eating psychopathology, whereas masculinity was associated with relatively healthy eating-related attitudes and behaviors. When considering the role of sexual orientation, these links were specific to homosexual men and women. CONCLUSIONS: In relation to homosexual men and women, the results support a model where femininity might be seen as a specific risk factor for eating disorders, whereas masculinity is likely to be a protective factor. Methodological and conceptual implications are discussed.     

Disordered eating in three communities of China: a comparative study of female high school students in hong kong, Shenzhen, and rural hunan

OBJECTIVE: To examine disordered eating and its psychological correlates among female high school students in three Chinese communities that lay on a gradient of socioeconomic development in China. METHOD: 796 Chinese students from Hong Kong, Shenzhen, and rural Hunan completed a demographic and weight data sheet, the Eating Attitudes Test (EAT-26), a Body Dissatisfaction Scale (BDS), the Beck Depression Inventory (BDI), and the Rosenberg Self-Esteem Scale (RSES). RESULTS: Compared to students in Hunan and to a lesser extent students in Shenzhen, students from Hong Kong were slimmer, but desired a lower body mass index (BMI), reported more body dissatisfaction, exhibited a more typical EAT-26 factor structure, scored higher on the "fat concern and dieting" factor, and constituted more EAT-26 high scorers. Multiple regression analyses indicated that BDS was the most significant predictor of fat concern at each site, but this effect was strongest in Hong Kong. Hunan students had significantly higher BDI scores but lower fat concern than Shenzhen and Hong Kong students. DISCUSSION: The consistent gradient of fat concern across the three communities gives credence to the view that societal modernization fosters disordered eating in women, possibly via the gendered social constraints that accompany it. It is also expressive of the marked socioeconomic heterogeneity within China nowadays. The predictable rising rate of eating disorders that follows global change will pose a growing public health challenge to Asian countries.     

Alexithymia and its relationships with body checking and body image in a non-clinical female sample

The aim of the present study was to evaluate in a non-clinical sample of undergraduate women, the relationships between alexithymia, body checking and body image, identifying predictive factors associated with the possible risk of developing an Eating Disorder (ED). The Toronto Alexithymia Scale (TAS-20), Body Checking Questionnaire (BCQ), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ), Interaction Anxiousness Scale (IAS), Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI) were completed by 254 undergraduate females. We found that alexithymics had more consistent body checking behaviors and higher body dissatisfaction than nonalexithymics. In addition, alexithymics also reported a higher potential risk for ED (higher scores on EAT-26) when compared to nonalexithymics. Difficulty in identifying and describing feelings subscales of TAS-20, Overall appearance and Specific Body Parts subscales of BCQ as well as lower self-esteem was associated with higher ED risk in a linear regression analysis. Thus, a combination of alexithymia, low self-esteem, body checking behaviors and body dissatisfaction may be a risk factor for symptoms of ED at least in a non-clinical sample of university women.     

Influence of sexual orientation and age on disordered eating attitudes and behaviors in women

OBJECTIVE: We evaluated the influence of age on the association between sexual orientation and disordered eating attitudes and behaviors in women. METHOD: Heterosexual (n=47) and homosexual (n=45) women recruited from the community completed self-report questionnaires including the Body Esteem Scale, the Eating Disorders Inventory-2, the Reasons for Exercise Inventory, and the Self Esteem Scale. RESULTS: A multivariate analysis of variance of eating disorder variables revealed a main effect for sexual orientation on drive for thinness and exercise to control weight and a main effect for age on body mass index (BMI) and body dissatisfaction, but it did not reveal a significant interaction between sexual orientation and age. DISCUSSION: Sexual orientation may influence certain types of disordered eating attitudes and behaviors in women such as endorsing an extreme ideal of thinness. However, homosexual and heterosexual women reported more similarities than differences.     

Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel

OBJECTIVE: This study explores the association between gender and exposure to Western culture and attitudes toward eating. METHOD: Four hundred and ninety-nine university students participated in the study: 216 Israeli natives, 153 new immigrants (3 years or less since immigration) from the Former Soviet Union (FSU), and 130 veteran immigrants from FSU (4-15 years since immigration). Attitudes toward eating were measured using the Eating Attitude Test - EAT-26. RESULTS: Israeli born women had higher weight and body mass index (BMI) than did new immigrant women. Higher scores on the EAT-26 were found among women than among men. Among women only, native-born Israelis and veteran immigrants were more likely to have positive EAT-26 scores (19.6%, 18.8%) than were new immigrant women (7.9%), indicating disordered eating attitudes. Part of the differences in EAT-26 scores was explained by differences between the groups on age and BMI; however, even after adjustment the differences remained significant on the bulimia subscale. CONCLUSION: The results suggest a rapid cultural effect in attitudes toward eating that may reflect a tendency toward eating disorders as well as a difference in the proportion of obesity. It seems that the veteran immigrants have adopted Western cultural norms and eating patterns in a way that has erased the differences in tendency toward eating disorders between them and the Israeli born women.     

Neuroticism and introversion: a risky combination for disordered eating among a non-clinical sample of undergraduate women

Recent evidence suggests that people who score low on measures of sociability may be at risk for certain types of psychopathology, including mood and anxiety disorders. In an attempt to extend these findings to other forms of psychopathology, we examined levels of neuroticism and extraversion in relation to eating problems in a non-clinical sample of undergraduate women. The Eysenck Personality Questionnaire (EPQ), Eating Disorders Inventory (EDI), and the Eating Attitudes Test (EAT-26) were completed by 196 first-year undergraduate females. We found that high neuroticism was related to high scores on both of the EDI subscales (Bulimia and Drive for Thinness) as well as high scores on the EAT-26 measure, replicating previous work. In addition, neuroticism served as a moderator such that lower extraversion (i.e., introversion) was related to greater disordered eating, but only for those women who scored high on neuroticism. Thus, a combination of neuroticism and introversion may be a risk-factor for symptoms of eating disorders in a non-clinical sample of university women.     

Reducing risk factors for eating disorders: targeting at-risk women with a computerized psychoeducational program

OBJECTIVE: This controlled study evaluated whether an 8-week program offered over the Internet would significantly decrease body image dissatisfaction, disordered eating patterns, and preoccupation with shape/weight among women at high risk for developing an eating disorder. METHOD: Fifty-six college women were recruited on the basis of elevated scores (> or =110) on the Body Shape Questionnaire (BSQ). Psychological functioning, as measured by the Eating Disorder Inventory Drive for Thinness (EDI-DT) subscale, Eating Disorder Examination-Questionnaire (EDE-Q), and the BSQ, was assessed at baseline, posttreatment, and at 10-week follow-up. RESULTS: All participants improved over time on most measures, although effect sizes suggest that the program did impact the intervention group. DISCUSSION: Findings suggest that technological interventions may be helpful for reducing disordered eating patterns and cognitions among high-risk women. Future research is needed to assess whether such programs are effective over time for prevention of and reduction in eating disorder symptomatology.     

Correlation between the EAT-26 and the EAT-40, the Eating Disorders Inventory,and the Restrained Eating Inventory

The 40-item Eating Attitudes Jest, the 26-item Eating Attitudes Test, the Restrained Eating Inventory (El), and the Eating Disorders Inventory (EDI) were given to 81 women who were participating in an eating disorders study. The EAT-26 totals and the scores of the three factors were intercorrelated. The scores of the EAT-26 were also correlated with the scores of the EAT-40, and El, and the EDI. The EAT-26 correlated significantly with all three of its factors as well as with the EAT-40. These results suggest that the EAT-26 is a reliable and economical substitute for the EAT-40. The EAT-26 correlates highly with the eight subscales of the EDI and with the El, suggesting concurrent validity.     

Rapid screening for disordered eating in college-aged females in the primary care setting.

PURPOSE: To identify an efficient, valid, and reliable instrument for use by primary care physicians during clinical encounters to screen female adolescents at risk for eating disorders. METHODS: We created a survey of 36 questions, including the Eating Attitude Test-26 (EAT-26) and additional test questions identified through focus groups and literature review. The EAT-26 is a valid and reliable tool to identify individuals with eating disorders (1). We randomly distributed the survey to 865 college freshman women residing in dormitories at the University of Florida. The EAT-26 portion of the survey was scored according to established protocol. A score of > or =20 identified individuals likely to have an eating disorder, including anorexia nervosa and bulimia nervosa. RESULTS: 402 women completed surveys for a response rate of 47%. Based on the EAT-26 scores greater than 20, 17% of our population had scores predictive of an eating disorder. Four test questions correlated with positive EAT-26 scores: "How many diets have you been on in the past year?"; "Do you feel you should be dieting?"; "Do you feel dissatisfied with your body size?"; and "Does your weight affect the way you feel about yourself?" CONCLUSIONS: These four test questions in written format screen for disordered eating among female college students in primary care settings.     

Risk for disordered eating relates to both gender and ethnicity for college students

OBJECTIVE: To estimate the frequency of disordered eating behaviors among college students and associations by gender, ethnicity, participation in social organizations and college athletics and to determine whether responses to eight health behavior and attitude questions and body weight predicted a high score on the Eating Attitudes Test (EAT)-26, a screening instrument used to identify risks of developing an eating disorder. METHODS: Subjects were a convenience sample of 1,899 college students (cleaned to 1620) who attended four classes, were members of 14 sororities or lived in five residence halls. Students reported height and weight and responded to the EAT-26 and eight items regarding health behaviors and attitudes. RESULTS: Among women and men, 4.5% and 1.4%, respectively, reported previous treatment for an eating disorder, and 10.9% of women and 4.0% of men were at risk for eating disorders (scores > or = 20 on EAT). Among African-Americans, 8.3% of women were at risk. One group of women who lived separately in a social sorority had the highest risk of 15%. The frequency of "weight concerns interfering with academic performance" and "eliminating high fat foods" was moderately correlated to risk for disordered eating for both genders. Body mass only weakly related to risk for disordered eating and the association varied by subgroup. CONCLUSION: Students at risk for disordered eating report weight concerns interfering with their academic performance and include both men and African-Americans, as well as Caucasian American women. Sorority women living in separate residences might be at increased risk.     

Anxiety of young female athletes with disordered eating behaviors

The aim of this study was to investigate the prevalence rate of disordered eating behaviors in young female athletes and to compare the anxiety levels of the athletes with or without disordered eating behaviors. Female athletes (n=243) of 15 to 25 years old from the city, Edirne, in Turkey participated our study. Disordered eating behaviors and anxiety levels of participants were evaluated by the Eating Attitudes Test (EAT-40) and State-Trait Anxiety Inventory. Disordered eating behaviors was reported as 40 (16.7%) among all athletes. Both state and trait anxiety scores were higher in athletes with disordered eating behaviors than the athletes without disordered eating behaviors (p=0.01). The athletes who engage in leanness and non leanness sports were reported as having similar EAT-40 scores and anxiety scores. In conclusion, athletes with disordered eating behaviors have higher state and trait anxiety scores.     

Similarities and differences between women and men on eating disorder risk factors and symptom measures

Researchers studying eating disorders in men often use eating disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, we report on the validity of doing so with a set of measures chosen to reflect a wide range of risk factors and symptoms. The Bulimia Test-revised (BULIT-R), the restraint scale (RS), the three-factor eating questionnaire (TFEQ), the Eating Expectancy Inventory, and the eating attitudes test (EAT) all had the same factor structures for both genders, and tests of invariance showed that factor loadings, factor variances, and intercorrelations among factors were equivalent across gender. A modified Structured Clinical Interview for DSM-IV anorexic symptoms questionnaire did not perform adequately for either gender. Men produced slightly less reliable scores on virtually all measures, with the result that Pearson-based estimates of correlations among the measures were slightly lower for men. Men had lower scores on symptom and risk measures, but not on other eating measures.     

The prevalence of subclinical eating disorders among male cyclists

Disordered eating behaviors are typically seen as a problem in females and there are little data assessing their prevalence in males. The objective of the present cross-sectional investigation was to identify subclinical disordered eating patterns and dietary characteristics among competitive male cyclists. A nutritional questionnaire, the Eating Attitudes Test-26 (EAT-26), and Survey of Eating Disorders Among Cyclists, were completed by male cyclists (n=61) and noncyclists (n=63). Male cyclists scored significantly higher on the EAT-26 compared to the male control group (P<0.001). Of the 12 cyclists who showed the greatest tendency toward disordered eating (EAT-26 >20), only five self-reported having an eating disorder. Approximately half the cyclists believed eating disorders were somewhat common in the sport (28 of 60). The nutritional questionnaire revealed that male cyclists may not consume adequate nutrients to sustain their metabolic needs. Thus, the results of this study suggest that male cyclists may not know how to identify disordered eating habits and may be at an amplified risk for eating disorders and nutritional deficits. Further research should utilize various measures to address the prevalence of disordered eating in a larger sample size and quantify energy balance.     

The Cognitive, Behavioral, and Personality Profiles of a Male Monozygotic Triplet Set Discordant for Sexual Orientation

The neurohormonal theory of sexual orientation proposes that homosexual men and homosexual women are exposed prenatally to a hormonal environment that is similar to that of the other sex. Prenatal exposure to an opposite-sex hormonal environment may lead the nervous system to develop in a manner consistent with the opposite sex. If this cross-sex exposure occurs, one prediction would be that the cognitive ability profile of homosexual men would be similar to that of heterosexual women. This study examined a set of male monozygotic triplets, aged 21 years, discordant for sexual orientation: 2 of the triplets were heterosexual, 1 was homosexual. The triplets were administered measures of 23 domains of cognitive ability, as well as measures of sexual orientation and masculinity/femininity. On the measures of cognitive ability, the triplets performed similarly, yet consistent differences were found between the 2 heterosexual triplets and the 1 homosexual cotriplet. Differences having the same pattern were found for the number of Schafer homosexuality signs on the Rorschach, and on a homosexuality scale derived from items on the Minnesota Multiphasic Personality Inventory--2 (MMPI-2). Responses from the homosexual triplet were in a more feminine direction than responses from his 2 heterosexual cotriplets on measures of masculinity-femininity, which included measures derived from Rorschach responses, the MMPI-2 Masculinity-Femininity scale, the Bem Sex Role Inventory, and the Boyhood Gender Conformity Scale. Responses to the 16 Personality Factor Questionnaire also distinguished the 1 homosexual triplet from the 2 heterosexual cotriplets. These findings support the view that the prenatal hormonal environment may have enduring effects on selected behavioral traits.     

Trans-cultural comparison of disordered eating in Korean women

OBJECTIVE: The presence of eating disorders in non-Western cultures is often attributed to the export of Western ideals. This study examines this hypothesis by comparing disordered eating attitudes and behaviors in Korean women with differing levels of exposure to Western culture. METHOD: Second-generation Korean-Americans (n=167) and Korean immigrants (n=37) completed the Eating Attitudes Test (EAT-26), and data from native Koreans (n=937) were obtained from a previous epidemiological study, using a Korean-translated version of the EAT-26 (K-EAT-26). Korean-American and immigrant women completed the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA). RESULTS: Korean-American women scored significantly lower on the EAT-26 than Korean immigrants and native Koreans, who did not differ from each other. Korean-Americans were more Western-oriented than Korean immigrants, and acculturation levels were not correlated with EAT-26 scores in either group. CONCLUSION: This study supports the importance of native cultural factors in the development of eating disorders in non-Western contexts.     

Attitudes toward gay men and lesbians and related factors among nurses in Southern Taiwan

OBJECTIVES: The aims of this study were to explore different dimensions of the attitudes toward gay men and lesbians among nurses in southern Taiwan and to examine the association between attitudes and intention to provide care to homosexual individuals. The factors related to attitudes towards gay men and lesbians by nurses were also examined. METHODS: In total, 1824 nurses from a medical centre and two regional teaching hospitals in southern Taiwan were recruited into this study. We used the Attitudes Toward Homosexuality Questionnaire (ATHQ) to examine four-dimensional concepts toward homosexuality among nurses. The association of attitudes with the intention of taking care of homosexual patients was examined. Correlations of attitudes toward homosexuality with demographic and occupational data, sexual orientation, knowledge about homosexuality, and experiences of having contact with gay men and lesbians were examined using a stepwise multiple linear regression. RESULTS: Participants had the most negative attitude toward homosexuality in the 'contact' and 'stereotypes' dimensions, followed by the 'morality' dimension and then the 'condemnation/tolerance' dimension. Nurses with more negative attitudes toward homosexuality had lower intentions of taking care of patients with a homosexual orientation. Nurses who had friends or relatives with a homosexual orientation, had a higher educational degree, and had provided care to homosexual patients were more likely to have positive attitudes toward homosexuality. In contrast, nurses who had worked for a longer period, labelled themselves as being absolutely heterosexual, and were religious were more likely to have negative attitudes toward homosexuality. CONCLUSIONS: The factors related to attitudes toward homosexuality identified in this study have to be taken into consideration when intervening for nurses' attitudes toward gay men and lesbians.     

Eating attitudes in college males

Three hundred and forty male college students participated in a survey study of eating attitudes. Participants completed a survey including demographic data, a weight history, and the Eating Attitudes Test (EAT-26). Twelve subjects or 3.5% of the population had elevated scores of 20 or above on the EAT-26. Elevated scores correlated significantly with body building and with a past history of obesity. Fully 65% of the men reported weighing within 5 percentage points of their ideal weight. The authors suggest that males who are overinvested in their bodies and physical appearances are at higher risk for developing eating disorders.     

The Relationship Between Digit Ratio (2D:4D) and Sexual Orientation in Men from China

We examined the relationship between 2D:4D digit ratio and sexual orientation in men from China and analyzed the influences of the components used to assess sexual orientation and the criteria used to classify individuals as homosexual on this relationship. A total of 309 male and 110 female participants took part in a web-based survey. Our results showed that heterosexual men had a significantly lower 2D:4D than heterosexual women and exclusively homosexual men had a significantly higher left 2D:4D than heterosexual men whereas only exclusively homosexual men had a significantly higher right 2D:4D than heterosexual men when sexual orientation was assessed via sexual attraction. The left 2D:4D showed a significant positive correlation with sexual identity, sexual attraction, and sexual behavior, and the right 2D:4D showed a significant positive correlation with sexual attraction. The effect sizes for differences in 2D:4D between homosexual and heterosexual men varied according to criteria used to classify individuals as homosexual and sexual orientation components; the more stringent the criteria (scores closer to the homosexual category), the larger the effect sizes; further, sexual attraction yielded the largest effect size. There were no significant effects of age and latitude on Chinese 2D:4D. This study contributes to the current understanding of the relationship between 2D:4D and male sexual orientation.     

Cultural and western influences on the nutrition transition in Thailand

The impact of economic development and urbanisation on nutrition and dietary changes in transitional countries has been well researched. It generally has been found that there is a positive correlation between economic development, urbanization, and negative nutrition transitions with the result of growing levels of obesity and diet related non-communicable diseases. However, the impact of Western influences and culture on specific eating styles associated with the nutrition transition has been less studied. There is limited information about cultural and Western influences on eating styles in Thailand. Recent findings suggest that Thailand may have progressed further along the nutrition transition model, in terms of unhealthy eating styles, than would be expected based on economic development. This study was designed to determine the prevalence of current eating styles and eating motivations among Thai university students. University students were chosen for evaluation as they are thought to represent the forefront of dietary trends and nutrition changes in a population. Convenience samples from four different universities in south-central and northern Thailand were selected. The following scales were used to assess eating and dieting styles and attitudes among 662 Thai undergraduate and graduate students: Motivation For Eating Scale (MFES), Eating Attitudes Test-26 (EAT-26), and Cognitive Dieting Behavior Scale (CBDS). All scales have been shown to be reliable and valid in previous research. For this study, scales were translated into Thai, reverse translated, and pilot tested to ensure cultural relevancy and the conveyance of intended meanings. Basic demographic information was also obtained, including age, gender, year in school, marital status, height and weight, and income. Results indicated that Thai students exhibit significant levels of dieting behaviour and extrinsic eating based on CBDS and MFES scores (with the exception of environmental eating). For most negative eating styles, females scored higher than males. It was also found that high levels of dieting and extrinsic eating were positively correlated with body mass index, suggesting the possible risk of future weight gain and obesity. While the occurrence of eating disordered attitudes based on EAT-26 scores was low (13%), analysis of EAT-26 scores indicated that the occurrence of eating disordered attitudes was strongly correlated with dieting behaviour among this population. The results support the need for a programme to educate Thai students, especially females, regarding healthy patterns of dieting and eating attitudes in order to prevent future weight gains and eating disorders predicted by the nutrition transition model.     

Gender Atypicality and Anxiety Response to Social Interaction Stress in Homosexual and Heterosexual Men

Gender non-conforming behavior and a homosexual sexual orientation have both been linked to higher levels of anxiety. This study examined the independent and interactive effects of gender atypicality and sexual orientation on levels of state anxiety immediately following a stressful social interaction task among a sample of homosexual and heterosexual Israeli men (n = 36). Gender atypicality was measured via both self-report and observer ratings. State anxiety was measured via both self-report immediately subsequent to the stressful social interaction task and pre- to post task changes in salivary cortisol. Results showed that self-reported gender atypicality and heterosexual sexual orientation predicted higher levels of self-reported social interaction anxiety, but not changes in cortisol. There were no sexual orientation by gender behavior interactions and there were no significant effects for observer rated gender atypicality. These findings suggest that gender atypicality, not homosexuality, place individuals at risk for increased anxiety.