Sexual Minority Stress and Social Support Explain the Association between Sexual Identity with Physical and Mental Health Problems among Young Lesbian and Bisexual Women

Bisexual women report more physical and psychological health problems than lesbian women do, which may be attributed to greater sexual minority stress and less social support. However, many studies combine lesbian and bisexual women into a single group. The current study examined if sexual minority stress and social support mediated the association between women’s sexual identity (lesbian or bisexual) and health-related outcomes. A total of 650 U.S. young adult lesbian (n?=?227) and bisexual (n?=?423) women completed an online survey about sexual minority stress, social support, and physical and mental health problems. Bisexual women reported more physical and mental health problems. A sequential mediation model showed that bisexual women reported greater sexual minority stress than lesbian women, which in turn was associated with less social support, which was associated with more physical and mental health problems. Greater sexual minority stress and lower social support may help explain why bisexual women report more health-related problems than lesbian women. The results of the present study support the importance of examining risk and protective factors for health problems separately for lesbian and bisexual women. Health-related intervention programs that target sexual minority women may need to be tailored differently for lesbian and bisexual women.

     

Defining features of unhealthy exercise associated with disordered eating and eating disorder diagnoses

ObjectivesThe current study sought to compare different features of unhealthy exercise on associations with disordered eating and their ability to identify individuals with eating disorders. A secondary aim of the study was to compare prevalence and overlap of different aspects of unhealthy exercise and potential differences in their gender distribution.DesignCross-sectional epidemiological study.MethodsA community-based sample of men (n = 592) and women (n = 1468) completed surveys of health and eating patterns, including questions regarding exercise habits and eating disorder symptoms.ResultsCompulsive and compensatory features of exercise were the best predictors of disordered eating and eating disorder diagnoses compared to exercise that was excessive in quantity. Further, compulsive and compensatory aspects of unhealthy exercise represented overlapping, yet distinct qualities in both men and women.ConclusionsIncluding the compulsive quality among the defining features of unhealthy exercise may improve identification of eating disorders, particularly in men. Results suggest that the compensatory aspect of unhealthy exercise is not adequately captured by the compulsive aspect of unhealthy exercise. Thus, interventions that target unhealthy exercise behaviors among high-risk individuals, such as athletes, may benefit from addressing both the compulsive and compensatory aspects of unhealthy exercise. Future prospective longitudinal studies will aid in determining the direction of the association between these features of unhealthy exercise and the onset of eating pathology.     

Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the "gay-friendly" Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed.     

Minority Stress and the Risk of Unwanted Sexual Experiences in LGBQ Undergraduates

Sexual assault is prevalent among lesbian, gay, bisexual, and queer (LGBQ) college students, but its relationship to anti-LGBQ stigma has not been established. The goal of the present study was to determine whether minority stress, specifically internalized homophobia, predicted unwanted sexual experiences among LGBQ undergraduates (N = 763), whether routine behaviors (number of consensual sexual partners and alcohol use) mediated this relationship, and whether sense of LGBTQ community was a protective factor. Significant proportions of sexual minority men (10 %), women (18 %), and non-binary or transitioning students (19 %) reported an unwanted sexual experience since entering college. Internalized homophobia was associated with greater risk of unwanted sexual experiences. It also had a negative indirect effect on unwanted sexual experience risk through a negative association with number of sexual partners. Alcohol use did not mediate the relationship between internalized homophobia and unwanted sexual experiences. Sense of LGBTQ community was associated with lower risk, mediated by lower levels of internalized homophobia. The relationships between internalized homophobia and unwanted sexual experience risk were similar for women and men. These findings demonstrate that minority stress increases LGBQ students’ risk of sexual victimization and that in-group social relationships can mitigate this risk. We argue that minority stress is an important risk factor for sexual violence. Violence prevention interventions should attempt to reduce internalized homophobia, and colleges and high schools should establish LGBQ-affirming social climates and provide resources for LGBQ students, including targeted violence prevention efforts and programs that foster a sense of supportive community.     

Attributes of successful approaches to weight loss and control

Most weight loss treatments result in only temporary losses, followed by slow regain. This paper examines those factors that are correlated with the most favorable results in terms of loss and maintenance of loss. Weight loss is positively related to self-monitoring, goal setting, social support, and length of treatment. Maintenance of weight loss is correlated with regular physical activity, self-monitoring, and continued contact with therapists. Regain is associated with inconsistent and restrictive dieting, life stress, negative coping style, and emotional or binge eating patterns. The implications drawn from these findings are (a) normalize eating patterns, (b) emphasize exercise, (c) ensure social support, (d) set realistic goal weights, (e) focus on health rather than appearance, (f) focus on self-esteem, and (g) target binge eating.     

The Impact of Cumulative Minority Stress on Cognitive Behavioral Treatment With Gender Minority Individuals: Case Study and Clinical Recommendations

For sexual minority individuals (i.e., lesbian, gay, and bisexual [LGB] persons), minority stress includes experiences of discrimination, expectations of rejection, internalized negativity, and concealment of identity. Sexual minority stress has been linked to various negative mental health outcomes (e.g., depression, anxiety), and levels of psychiatric comorbidity are high among LGB people. However, little is known about the extension of minority stress models to gender minority individuals (i.e., transgender and gender nonconforming persons) and its impact on mental health in this particular group. Further, the influence of gender minority stress on the delivery and outcome of traditional cognitive behavioral therapy (CBT) approaches is unclear. A case study of CBT for chronic depression with a young, transgender individual is presented. This case study highlights potential barriers that may arise with gender minority clients when implementing evidence-based clinical interventions in the context of an individual’s minority stress history. Implications for cognitive-behavioral treatments with gender minority individuals and recommendations for clinicians and researchers are discussed.     

Anxiety and Related Disorders and Concealment in Sexual Minority Young Adults

Sexual minorities face greater exposure to discrimination and rejection than heterosexuals. Given these threats, sexual minorities may engage in sexual orientation concealment in order to avoid danger. This social stigma and minority stress places sexual minorities at risk for anxiety and related disorders. Given that three fourths of anxiety disorder onset occurs before the age of 24, the current study investigated the symptoms of generalized anxiety disorder, social phobia, panic disorder, posttraumatic stress disorder, and depression in sexual minority young adults relative to their heterosexual peers. Secondarily, the study investigated sexual orientation concealment as a predictor of anxiety and related disorders. A sample of 157 sexual minority and 157 heterosexual young adults matched on age and gender completed self-report measures of the aforementioned disorders, and indicated their level of sexual orientation concealment. Results revealed that sexual minority young adults reported greater symptoms relative to heterosexuals across all outcome measures. There were no interactions between sexual minority status and gender, however, women had higher symptoms across all disorders. Sexual minority young women appeared to be at the most risk for clinical levels of anxiety and related disorders. In addition, concealment of sexual orientation significantly predicted symptoms of social phobia. Implications are offered for the cognitive and behavioral treatment of anxiety and related disorders in this population.     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.     

Tests of Objectification Theory in Gay, Lesbian, and Heterosexual Community Samples: Mixed Evidence for Proposed Pathways

Objectification theory (Fredrickson and Roberts 1997) proposes that women are especially vulnerable to eating disordered behavior when they live in cultures in which their bodies are a constant focus of evaluation. The current study examined whether predictions of objectification theory involving the associations among sexual objectification, body surveillance, body shame, and eating disordered behavior were supported in groups that varied by both gender and sexual orientation. Adults from a U.S. community sample in the Chicago area (92 heterosexual women; 102 heterosexual men; 87 gay men; and 99 lesbian women) completed self-report measures of these constructs. Results suggest that group differences in experiences of sexual objectification and body surveillance may partially explain gender and sexual orientation-based differences in eating disordered behavior.     

Self-Oriented Body Comparison and Self-Compassion: Interactive Models of Disordered Eating Behaviors Among Postpartum Women

Evidence suggests self-oriented body comparison (comparison of one’s postpartum body shape and weight to one’s prepregnant body shape and weight) is a critical factor associated with increased levels of disordered eating during the postpartum period. However, some postpartum women adopt a self-compassionate and acceptance-based perspective toward their body shape and weight changes. It is unclear whether self-compassion may buffer the associations between self-comparisons and disordered eating behaviors among postpartum women, which is the aim of the current study. A total of 306 postpartum women who gave birth in the past year completed an online survey asking about self-compassion, social comparison, broad eating pathology, dietary restraint, and binge eating. Results indicated that self-compassion appeared to buffer the associations between self-comparison and broad eating pathology and binge eating among postpartum women, such that for women with above-average levels of self-compassion, the associations between self-comparison and disordered eating was weaker than for women with average or below-average levels of self-compassion. Findings suggest self-compassion could be a potential target for intervention programs.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Acculturation, Birthplace and Alcohol-Related Social Problems Across Hispanic National Groups

OBJECTIVE: To examine the association between acculturation, birthplace, and alcohol-related social problems across Hispanic national groups. METHOD: 5,224 Hispanic adults (18+ years) were interviewed using a multistage cluster sample design in Miami, New York, Philadelphia, Houston, and Los Angeles. RESULTS: Multivariate analysis shows no association between acculturation and problems among men or women. Birthplace is a risk factor for social problems among both genders. Among men, Mexican Americans, Puerto Ricans, and South/Central Americans are more likely to report social problems than Cuban Americans. Other risk factors for men are unemployment, a higher volume of drinking, and a higher frequency of binge drinking. Among women, Mexican American origin and binge drinking are also risk factors for reporting problems. CONCLUSIONS: U.S.-born Hispanics may experience stress and other detrimental effects to health because of their minority status, which may increase the likelihood of more drinking and the development of alcohol-related problems.     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

A TEST OF OBJECTIFICATION THEORY WITH LESBIAN WOMEN

This study extends research on objectification theory as it applies to eating disorder symptomatology by examining whether its tenets generalize to women identifying as lesbian. Lesbian women ( N = 181) and a comparison sample of heterosexual women ( N = 196) completed measures of objectification theory constructs (interpersonal sexual objectification, body surveillance, body shame, interoceptive awareness, disordered eating). The model of objectification theory was tested separately for lesbian and heterosexual participants. Path analyses revealed that this model provided a poor fit to the data for the lesbian sample, whereas it provided an excellent fit to the data for the heterosexual sample. Based on the data from the lesbian participants, an exploratory model was evaluated. Overall, findings suggested that the interrelationships among the objectification theory constructs were different and more complex for the lesbian participants than for the heterosexual participants.     

An examination of the Clinical Impairment Assessment among women at high risk for eating disorder onset

Identifying measures that reliably and validly assess clinical impairment has important implications for eating disorder (ED) diagnosis and treatment. The current study examined the psychometric properties of the Clinical Impairment Assessment (CIA) in women at high risk for ED onset. Participants were 543 women (20.6 ± 2.0 years) who were classified into one of three ED categories: clinical ED, high risk for ED onset, and low risk control. Among high risk women, the CIA demonstrated high internal consistency (α = 0.93) and good convergent validity with disordered eating attitudes (rs = 0.27-0.68, ps < 0.001). Examination of the CIA's discriminant validity revealed that CIA global scores were highest among women with a clinical ED (17.7 ± 10.7) followed by high risk women (10.6 ± 8.5) and low risk controls (3.0 ± 3.3), respectively (p < 0.001). High risk women reporting behavioral indices of ED psychopathology (objective and/or subjective binge episodes, purging behaviors, driven exercise, and ED treatment history) had higher CIA global scores than those without such indices (ps < 0.05), suggesting good criterion validity. These data establish the first norms for the CIA in a United States sample. The CIA is psychometrically sound among high risk women, and heightened levels of impairment among these individuals as compared to low risk women verify the relevance of early intervention efforts.     

Latent structure of dieting among female high-school students in Japan

The purpose of the present study was (1) to clarify whether individuals could be classified in terms of dieting using latent class analyses; and (2) to review the resulting classes were related to body dissatisfaction, body mass index, depressive mood, and binge eating. The present sample comprises 441 Japanese high-school girls. The optimal solution consisted of three latent classes: (1) unhealthy dieter (27%); (2) healthy dieter (39%); and (3) nondieter (34%). Inclusion in the unhealthy dieter class was predicted by body dissatisfaction and the girls in this class showed a high frequency of binge eating, while that in the other classes was not associated with any variable. This study identifies three classes with regard to dieting among female high-school students in Japan.     

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.     

Stress-Induced Binge Eating: A Behavior Analytic Approach to Assessment and Intervention

Responses to acute or chronic stress may include behaviors, such as alcohol consumption, cigarette smoking, and altered eating patterns. In connection with the stress-eating relation, some researchers have suggested that certain stressors (e.g., psychological or emotional) may influence the direction (i.e., increase or decrease) of a person’s eating response. In a recent study, Connors and Morse (Int J Eat Disord 13:1–11, 2006) indicated that the physical and psychological stress associated with sexual trauma could result in an increase in food intake and nonstandard eating patterns. In consequence, this study describes a multifaceted intervention for a 24-year-old woman who experienced chronic stress and received a diagnosis of Binge Eating Disorder (American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. DSM-IV. Washington, DC: APA) following a series of unwanted sexual experiences. The behavior analytic intervention emphasized self-control, self-regulation, and physical activity. The treatment package resulted in a 19% reduction in the participant’s body weight, a 96% reduction in binge eating, and long-term adherence to an exercise routine.     

Relations among exercise type,self-objectification,and body image in the fitness centre environment: The role of reasons for exercise

ObjectiveThe study aimed to investigate different types of exercise, the role of exercise motivation and body image outcomes within the fitness centre environment.Design and methodParticipants were 571 female fitness class participants recruited from fitness centres. They ranged in age from 18 to 71 years and participated in a variety of fitness activities both within and outside of the fitness centre environment. Reasons for exercise, self-objectification, body esteem, and disordered eating symptomatology were assessed using questionnaire measures.ResultsTime spent exercising within the fitness centre environment was more highly related to body image and eating disturbance than time spent exercising outside of the fitness centre environment. Participation in cardio-based workouts (e.g., cardiovascular machines) was positively related to self-objectification, disordered eating behaviour, and appearance-related reasons for exercise, and negatively related to body esteem. In contrast, participation in yoga-based fitness classes was related to lower self-objectification and exercising more for health and fitness. Appearance-focused reasons for exercise were found to mediate the relationship between exercise types and self-objectification, disordered eating, and body esteem.ConclusionThe results show that the reasons women have for doing exercise provide a mechanism through which different types of exercise are associated with negative body image outcomes. Thus, despite the physical health-related benefits associated with regular physical activity, exercise motivated by appearance reasons (e.g., weight control) can lead to poorer body image in some women.     

DISORDERED EATING AND PERCEPTIONS OF CHILDHOOD ABUSE AMONG WOMEN IN A PRIMARY CARE SETTING

Research has demonstrated links between sexual abuse and disordered eating among women in college student and mental health samples. Little is known about such relationships among women from other samples or the relationship between other forms of childhood abuse as well as disordered eating (vomiting, starvation, laxative abuse). Prevalence of disordered eating was significantly higher among women who indicated a perceived childhood history of sexual, physical, or emotional abuse or who had personally witnessed violence.     

Call to Action: Recommendations for Justice-Based Treatment of Obsessive-Compulsive Disorder With Sexual Orientation and Gender Themes

Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance; identity concealment and discomfort; and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behavioral treatment of sexual orientation (SO) and gender-themed obsessive-compulsive disorder (OCD) has inadvertently reinforced anti-lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) stigma and contributed to minority stress in clients, treatment providers, and society at large. We present updated recommendations for treatment of SO- and gender-themed OCD through a more equitable, justice-based lens, primarily through eliminating exposures that contribute to minority stress and replacing them with psychoeducation about LGBTQ+ identities, and exposures to neutral and positive stimuli, uncertainty, and core fears. We also present recommendations for equitable research on SO- and gender-themed OCD.