Particularly in gay adolescents, diagnosing eating disorders and body dysmorphia will focus on identifying behaviors that sabotage weight gain, rather than cognitive distortions in how body weight or shape are experienced.3
As with any mental health struggle, the role of a behavioral health counselor is not to “fix” a client’s body image issues. Instead, a supportive therapist can allow gay men to confront their self-judgment and determine whether and how to dismantle it.
Knowing when to intervene with a client can be difficult. Clients may not immediately mention their body image concerns in a therapeutic relationship, but risky sexual behavior is a prominent warning sign. Condomless sex and sex under the influence of drugs or alcohol are often the result of underlying social issues like internalized homophobia, lack of self-esteem, social isolation, and lack of peer acceptance. Gay men with poor body image are also less likely to be adherent to their anti-retroviral therapy regimen if they are HIV-positive.4
To create a supportive environment for these conversations, practitioners may consider deconstructing their own notions about health and weight. When a provider begins with the assumption that all bodies have inherent worth, it becomes easier to help a client evaluate and dismantle the idea that their worth as a person is based in cultural body ideals. There is a small but growing contingent of educators and activists promoting information about “Health at Every Size,” emphasizing how weight loss has been falsely correlated with physical health in popular discourse despite the paucity of supporting research.
Therapists can also help clients deconstruct the idea of scarcity in their romantic lives. Research indicates that many gay men believe that the body needed to attract a dating partner is more difficult to obtain than what they personally consider an ideal body type.5 This suggests that competition for romantic partners is a significant factor in distorting body image in gay men. A skilled provider can help their client uncover the destructive nature of these assumptions about relationships and develop a worldview that allows for love and sex without competing with other gay or trans men’s bodies.
The Long Game
Mental health providers play an integral role in pushing back against society’s destabilizing influences. The toxic messages that create body dissatisfaction in gay men are not going anywhere fast. The media is saturated with “6-packs,” social groups perpetuate “fat talk” and body-shaming, and homophobia, transphobia, and racism continue to color our clients’ experiences. However, with providers’ support, clients can construct healthier self-concepts that reject the impossible beauty standards of today’s culture.
- Research on males and eating disorders: prevalence in men. NEDA. www.nationaleatingdisorders.org/research-males-and-eating-disorders. Updated 2016. Accessed April 4, 2017.
- Blashill AJ, Safren SA. Sexual orientation and anabolic-androgenic steroids in US adolescent boys. Pediatrics. 2014;133(3). doi:10.1542/peds.2013-2768
- McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016;63(6):1079-1090. doi:10.1016/j.pcl.2016.07.008
- Blashill AJ, Goshe BM, Robbins GK, Mayer KH, Safren SA. Body image disturbance and health behaviors among sexual minority men living with HIV. Health Psychology. 2014;33(7):677-680. doi:10.1037/hea0000081
- Fussner LM, Smith AR. It’s not me, it’s you: perceptions of partner body image preferences associated with eating disorder symptoms in gay and heterosexual men. J Homosex. 2015;62(10):1329-1344. doi:10.1080/00918369.2015.1060053