Reflections on Using the Eating Disorders Examination to Assess Eating Disorder Pathology in Queer Men.

Abstract

Objective: Queer men face potent appearance-related pressures that exacerbate their eating disorder risk. While the Eating Disorder Examination (EDE) is a widely used eating disorder assessment, queer men may experience unique motivations for disordered eating that may impact its administration in this population. To generate practical guidance for clinicians and researchers using the EDE, we qualitatively examined reflections from interviewers who administered the EDE to queer men.

Method: Thirteen provisionally or generally registered psychologists administered the EDE to 179 queer men (M_age = 39.52, 84.36% with an eating disorder diagnosis, 87.15% identifying as gay) to assess their eligibility for a clinical trial of an eating disorder's intervention in Australia. Interviewers provided written reflections on their experience administering the EDE, which were analyzed with reflexive thematic analysis.

Results: Interviewers noted that stringent norms around appearance, dieting, and exercise among queer men impaired men's insight into the harm caused by disordered behaviors, despite marked distress, and/or impairment. Usefully, interviewers noted the EDE helped men to gain insight into their disordered behaviors. Interviewers noticed that norms around dieting skewed what some participants perceived to be a "large" amount of food-this was useful context for interviewers to consider when distinguishing subjective from objective bulimic episodes.

Discussion: Interviewers administering the EDE to queer men should be cognizant of subcultural appearance-related pressures that may lead queer men to underreport impairment or to misjudge instances of their own overeating. Having this knowledge ahead of administering the EDE can equip interviewers to deliver this assessment accurately.