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Brianna M. Blake

Gay Youth, Eating Disorders, and Suicidality. Brianna M. Blake. Long Island University, C.W. Post. Background Literature.

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Brianna M. Blake

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  1. Gay Youth, Eating Disorders, and Suicidality Brianna M. Blake Long Island University, C.W. Post

  2. Background Literature • In a culture in which transgression against and harassment of gay youth is quite prevalent (Blashill & Plowishta, 2009), the potential effects that this general climate of rejection may have on male, homosexual adolescents are imperative to investigate. • During this period of developmental transition and identity formation, violating traditional gender-roles by being a gay male can often lead to peer-group exclusion or criticism. • Resulting isolation, role confusion, and self-doubt serve as potential risk factors for psychopathological development.

  3. Background Literature Eating Disorder Presentation Across Gender and Sexual Orientation • Eating disorders tend to manifest in adolescence and emerging adulthood. • Current epidemiologic studies suggest that between 1.4 and 2.0% of girls and women and between 0.1 and 0.2% of boys and men battle with anorexia nervosa during their lifetime (Stice & Bulik, 2008). • Research demonstrates that male and female patients do not differ significantly in their severity of dieting, frequency of bingeing, bingeing-purging, or vomiting(Bramon-Bosch, Troop, & Treasure, 2000) • Homosexual males are more likely than heterosexual males to report a poor body image, a perception of being overweight, frequent dieting, binge eating, and purging behaviors (French, Story, Remafedi, Resnick, & Blum, 1996).

  4. Background Literature • Among those men suffering from an eating disorder, 10-42% identify themselves as homosexual or bisexual, which on average is higher than the 6% base rate of homosexuality reported in the male population (Russel & Keel, 2002). • Homosexuality is implicated as a risk factor for eating disorder development.

  5. Background Literature Suicidality • Homosexual orientation in males, but not females, is significantly associated withsuicidalintent and suicide attempts (Remafedi et al., 1998). • In a study conducted by Remafedi et  al. (1998) highlighting the relationship between suicide risk and sexual orientation among adolescents, results concluded that 28.1% of bisexual/homosexual males, in contrast to 4.2% of heterosexual males, reported suicide attempts. • Attempts of suicide in gay adolescents tend to be more severe and lethal than those of their heterosexual counterparts

  6. Background Literature • Approximately 6% of female patients diagnosed with anorexia nervosa die per decade of illness and these patients are 11 times more likely to die than other women of a similar age (Stice& Bulik, 2008). • In this eating disorder type, the most common causes of death are acute starvation and suicide. • Most shockingly, the suicide rate for anorexia nervosa is 57 times higher than in the general population (Stice & Bulik, 2008).

  7. Background Literature • Given that: • There is an increased occurrence of suicide attempts and completion in gay male populations as compared to their heterosexual male counterparts, or females of either gay or heterosexual orientation (Remafedi, French, Story, Resnick, & Blum, 1998); and • Those with eating disorders are at elevated risk for suicide; then • It may be hypothesized that an amalgamation of such traits will further increase the rate of suicide in this particular population.

  8. Study Hypotheses • Hypothesis 1: • Gay males will be at significantly higher risk of suicide than straight males • Males with anorexia nervosa will be at significantly higher risk of suicide than non-eating disordered males. • Hypothesis 2: • Gay males with anorexia nervosa will be at significantly higher risk of suicide than gay males or males with anorexia nervosa exclusively.

  9. Methodology Participants • A total sample size of 200 boys between the ages of 13 and 18 were recruited and comprised two study groups: (a) adolescent males with anorexia nervosa-restricting type (n=100) and (b) non-eating disordered adolescent males (n=100). • Those in the eating disorder (ED), or clinical, sample were recruited from the Eating Disorder Resource Center of New York City (EDRNYC). • The non-eating disordered group was recruited from a local community-based recreation center. • Participants ranged in education from 8-12 years. • The sample of participants lacked racial diversity and were predominantly White (80%). • All participants were compensated for their participation in the form of a $10 Barnes & Noble gift card.

  10. Methodology Measures Demographic Questionnaire • On a self-report measure, participants were asked to indicate: • Age • Ethnicity • Level of Education • Sexual orientation • Rate the degree of comfortability with their sexual orientation on a five-point scale, ranging from 0 = not at all to 4 = very much. • Previous history of eating disorder (yes/no; if affirmative, eating disorder subtype)

  11. Methodology • Eating Disorder Inventory-3 (EDI-3; Garner, 2004) • The EDI-3 is a 91-item self-report instrument intended to discriminate the presence of anorexia nervosa, restrictive type, anorexia nervosa, binge-eating/purging type, and bulimia nervosa in females age 13-53 years. • The EDI-3 takes approximately twenty minutes to complete. • The EDI-3 yields adequate convergent and discriminant validity. The internal consistency of the item scores is satisfactory across clinical and nonclinical samples.

  12. Methodology • Suicide Probability Scale (SPS; Cull & Gill, 1988) • The SPS is a 36-item self-report instrument designed to assess risk of suicide in adolescents and adult ages 13 and older. • The SPS consists of four subscales: Hopelessness (HP), Suicide Ideation (SI), Negative Self-Evaluation (NSE), and Hostility (HS). • The suicide probability score can be interpreted in relation to an assessed risk level: a score of 0-24 represents a subclinical risk level, 25-49 represents a mild risk level, 50-74 represents a moderate risk level, and 75-100 represents a severe risk level. • The total SPS scale had an adequate internal consistency reliability and convergent validity as suggested by a Cronbach’salpha of .92.

  13. Methodology Procedure • In order to qualify for study inclusion in the clinical sample, participants must (a) have received a clinical eating disorder diagnosis from mental health professionals at the EDRNYC that currently satisfies all diagnostic criteria for anorexia nervosa and b.) exceed the cut-off score on the EDI-3 indicating the presence of anorexia nervosa, restricting type. • The criterion of amenorrhea was not used to determine diagnostic fulfillment due to the target male population. • In order to qualify for inclusion in the non-eating disorder sample, there had to be no current or past history of an eating disorder diagnosis or the use of restriction or compensatory behaviors as a means to regulate body shape or size. • Informed consent was obtained from all participants and their guardians (if under the age of 18). • The present study was approved by the Institutional Review Board (IRB).

  14. Methodology Design • The current study was non-experimental, as no active manipulation of variables was performed. • The independent variables of gay-identification and presence of anorexia nervosa, restricting type were assessed using the demographic questionnaire and the EDI-3, respectively. • The dependent variable, risk of suicide, was measured using the SPS. • Data was analyzed by performing a 2-way ANOVA analysis using SPSS statistical software version 15.0. • Significance was set at the p<.05 level.

  15. Results • Significant: Data analysis demonstrated that both hypotheses were supported and significant at the p<.05 level. Gay males were at significantly higher risk of suicide than their heterosexual counterparts (p<.05). Similarly, males with anorexia nervosa, restricting type, had a significantly higher risk of suicide than non-eating disordered males (p<.05). Additionally, those males that were both gay and endorsed anorexia nervosa were at significantly higher risk of suicide than those males that were exclusively gay or eating disordered (p<.05). • Nonsignificant: The first hypothesis was supported. Gay males were at significantly higher risk of suicide than their heterosexual male counterparts (p<.05). Similarly, males meeting diagnostic criteria for AN-RT had a significantly higher risk of suicide than males without an eating disorder (p<.05). However, the second hypothesis was nonsignficant at the p<.05 level. There was no significant difference in the risk of suicide in those males that were both gay and met criteria for AN-RT than in those males that were exclusively gay or had anorexia nervosa.

  16. Discussion • Significant: These findings have far-reaching implications for both eating disorder and suicide assessment and treatment: • Preventative measures should be implemented in adolescence to reduce the likelihood of eating disorder development, particularly targeting gay males rather than just females. • Additionally, when treating gay males with EDs, it is imperative for clinicians to be cognizant of the increased risk of suicide in this population

  17. Discussion Implications for future research • Recent studies have implicated temperamental traits, namely novelty seeking, in the development and maintenance of eating disorder symptomatology (Bishop, 2010). • Underlying temperamental characteristics in gay males with eating disorders may contribute to an increased risk of suicidal cognitions and behaviors. • Femininity as a risk factor for eating disorder development (Meyer, Blissett, & Oldfield, 2001); therefore, those gay males that identify with feminine characteristics may present with higher rates of ED pathology. • The compound effect of violating gender-roles, both by being a feminine, gay male and having a traditionally female-bound psychopathology, may yield an experience and symptom picture that overwhelmingly increases the risk of suicide.

  18. Discussion • NonsignificantLimitations: • The reliability of gay-identification in adolescent male populations • The instruments used to assess eating disorder pathology and risk of suicide may have impacted the outcome as well • EDI-3 – normed with female samples • SPS – relies on accurate self-report • Future research should investigate other subtypes of eating disorders that may be more relevant to the particular population of interest. • Research demonstrates that in females, suicide attempts are more frequently reported by those ED individuals that engaged in purgative behaviors as a main form of compensation (Favaroet al., 2008) – potentially investigate AN-BP?

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