Although anorexia nervosa and bulimia nervosa are reported primarily among women, men make up from 5% to 20% of patients with eating disorders. tudies also suggest that a disproportionate number of these men are gay or bisexual. In both community and clinical samples of men with eating disorders, from 14% to 42% are gay or bisexual (in contrast to about 3% of the U.S. male population). Numerous studies have found that, compared with heterosexual men, gay men have more behavioral symptoms indicative of eating disorders. In one study, the proportion of gay and bisexual men with symptoms related to eating disorders was 10 times higher than among heterosexual men (J Soc Clin Psychol. 2000;19:240).

A community study
Matthew B. Feldman, PhD and Ilan H. Meyer PhD recently interviewed 524 gay, lesbian, or bisexual men and women who were recruited from various New York City community venues, including bookstores, coffee shops, and social groups. The respondents were equally divided among men, women, whites, blacks, and Hispanics. A heterosexual comparison group included 65 white men and 63 white women. Diagnoses were made using the computer-assisted personal interview version 19 of the World Mental Health Composite International Diagnostic Interview, a fully structured measure used in the National Comorbidity Study. The authors assessed the presence of both lifetime and current (12 months) eating disorders, including full syndrome anorexia nervosa, bulimia nervosa, and binge eating disorder. This was the first study to assess Diagnostic and Statistical Manual (DSM) diagnostic categories rather than using measures indicative of eating disorders in community-based ethnically and racially diverse populations.

Higher incidence found among members of gay clubs
Compared with heterosexual men, gay and bisexual men had a significantly higher prevalence of life-time full-syndrome bulimia, subclinical bulimia, and any other subclinical eating disorders. There were no significant differences between heterosexual women and lesbians and bisexual women in the prevalence of any eating disorders. The incidence of eating disorders among lesbians and bisexual women was comparable to that found in heterosexual women.

Gay men who participated in a gay recreational organization or group had a significantly higher prevalence of current subclinical eating disorders, including anorexia, bulimia and/or binge eating disorder. Other results, however, did not show the same pattern. For example, men who were members of gyms, whether the gym had a primarily gay clientele or not, did not differ from respondents who were not gym members. Similarly, the authors did not find any association between the prevalence of current eating disorders and the number and percentage of lesbian- gay-bisexual affiliated groups and organizations where the respondent were members.

Younger men and women more likely to have subclinical bulimia
Younger lesbian, gay and bisexual men and women, or those from 18 to 20 years of age, were more likely to have subclinical bulimia compared with older participants, or those 30 to 59 years of age. The authors theorize that this pattern may be due to a cohort effect that suggests that the younger generation of men and women are more vulnerable to sociocultural messages about appearance. The finding that black and Latino gays, lesbians, and bisexuals have a prevalence of eating disorders at least as high as do whites has not been evaluated because racial/ethnicity has not yet been studied, according to the authors.

Younger patients are at higher risk
The findings suggest that clinicians and public health practitioners working with gay and bisexual men need to be aware of the clinical signs of eating disorders, and should be especially attentive to younger gay/lesbian/bisexual clients, who are at increased risk. They should also avoid commonly held conventions that lesbian and bisexual women are less vulnerable to developing eating disorders than are heterosexual women. Similarly, the authors note that racial and ethnic minorities are no less vulnerable to these disorders than are whites.