Developing a Measure of Non-Binary Gender (Genderqueer) Assessment
 
by: Lisa Michelson, B.A.
 
Classifications of gender identity, gender expression, and biological sex have become prevalent topics within contemporary healthcare conversations. These topics were once understood as a binary of options (i.e. male/female, masculine/feminine), but now these topics are viewed as a part of a spectrum (i.e. an individual can vary in how much they identify as “male” and “female”/”masculine” and “feminine”). However, the healthcare system has not yet been able to adapt its treatment plans, insurance plans, and other types of documentation within healthcare to this new ideology of gender and sex. This causes individuals who do not associate or perform as the stereotypical “male” or “female” (at the very least) to be misunderstood, and (at most) to receive inadequate healthcare.
 
Before we move on, let’s define some terms. Performing gender is “performing” one’s gender in alignment with societal expectations of that gender (i.e. a woman would be performing gender if she were to wear a dress). Non-performing gender is deviating from what culture depicts as an individual’s “authentic self,” or the individual’s identity that society is most comfortable with. Examples of non-performing gender are cross-dressing or identifying as transgendered. Heteronormativitiy are policies, beliefs, norms, and disciplinary mechanisms that reinforce the sex/gender system; for example, heteronormative culture endorses “female” and “male” sex designations on birth certificates. Cisnormativity is the expectation that all people are cissexual, that those assigned male at birth always grow up to be men and those assigned female at birth always grow up to be women. Not performing gender (i.e. cross-dressing or being transgendered) can cause a variety of negative outcomes, such as bullying and teasing, to be elicited. It is this performativity of being a “man” and being a “woman,” that has affected how individuals are treated within the healthcare system.
 
There are issues if an individual does not perform his/her/their gender identity. For example, Trans* individuals are poorly understood and medicated by healthcare professionals, who mostly lack training in Trans* healthcare. Because physicians are not trained in the treatment of Trans* individuals and because important healthcare documents force individuals to designate their sex as “male” or “female,” Trans* individuals experience systematic violence by the healthcare system; for example, they do not have the option of identifying as two genders on medical documents, if they feel their identity is a blend of male and female. If one does not follow the gender binary system, then one’s identity undergoes erasure and is not viewed as legitimate. There are serious ethical issues with forcing Trans*, inter-sexed, or non-binary individuals to associate with one of two genders if they view their identity as either a mixture of male and female, or one outside of the binary scale.
 
Because there are currently no assessments that attempt to understand gender separate from performativity, I, along with the EAT lab, have developed the Non-Binary Gender Assessment (NBGA). This assessment asks individuals questions about how they view themselves rather than through performativity questions. Traditional performativity questions assess items such as  “I like guns.” In scoring, this individual would be described as “masculine.” However, this is based off of stereotypical analysis of gender performativity within a heteronromative, cisnormative culture. In other words, it is unfair to attach masculinity to the “I like guns” statement. In fact, a female who considers herself feminine may like guns as well.
 
Instead, we are trying to develop a measure that does not rely on these stereotypes. In the Non-binary Gender Assessment (NBGA) individuals are asked questions regarding how they view their identity. For example, individuals have the opportunity to quantify their gender identity on a scale from 1 to 10 in three categories “Female,” “Male,” and “Other.” Allowing individuals to quantify their own gender rather than assigning them a gender based off performativity aids in the individual’s agency, which is defined as one’s ability to make an autonomous decision for himself/herself. Through this 62-item survey, individuals answer a series of questions regarding ones’ gender identity, gender expression, and biological sex; for example “I am afraid to not wear clothes in public because people will look at my body (i.e. at a swimming pool or sauna).” The individual is not marginalized by a series of “yes” or “no” questions, but rather have the opportunity to scale one’s answer and provide clarification for answers if desired.
 
The hope in creating this scale is to better understand an individual’s gender and sex identity. Additionally, the goal is to see if the NBGA illuminates any relationships between both gender and sex identity and eating disorders. Previous research suggests that there is a higher prevalence of eating disorders in non-binary populations when compared to the same demographic in binary populations (Feldman & Meyer, 2007; McClain & Peebles, 2016). If the NBGA is able to detect the parts of an individual’s gender and sex identity that can cause an increase prevalence in eating disorder symptoms, then this may help in better understanding why non-binary individuals engage in disordered eating behaviors in the first place. Stay tuned as the EAT lab continues to develop and validate this measure!

Culture and Eating Disorders
 
by: Benjamin J. Calebs, B.A.
 
Eating disorders have traditionally been viewed as impacting the lives of non-Hispanic White women in Western countries. Relatedly, there have been debates about the degree to which eating disorders may be culture-bound syndromes (Keel & Klump, 2003). The DSM-5 defines a cultural syndrome as “a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context” (American Psychiatric Association, 2013, p. 14). As you can imagine cultural and ethnic differences in eating disorders are a very complex topic!
 
Some researchers have argued that eating disorder diagnoses such as anorexia nervosa and bulimia nervosa are culture-bound syndromes motivated by Western ideals of thinness, while others have emphasized the substantial biological and genetic components to eating disorders. After a review of the evidence on eating disorders across cultures and time periods, Keel and Klump (2003) concluded that bulimia nervosa is heavily influenced by culture, while anorexia nervosa is experienced similarly across cultures. The authors suggest that bulimia nervosa may be so influenced by culture because binge eating is reliant upon an individual having access to enough available food to have a binge episode. Relatedly, purging seems to predominately occur in cultures where thinness is highly valued (Keel & Klump, 2003).
 
In spite of the traditional view of eating disorders outlined before (i.e., that eating disorders are predominately seen in non-Hispanic White, Western women), it is now clear that disordered eating behaviors occur across different ethnicities and cultures. Lifetime prevalence rates of eating disorders vary among ethnic groups in the United States, yet disordered eating has been found among European Americans, African Americans, Hispanic Americans, and Asian Americans (for a recent review see: Levinson & Brosof, 2016).
 
Our lab recently completed a review on disordered eating across ethnic groups. I will discuss a bit about what this review found. African American women tend to show lower levels of disordered eating behaviors than European American women, which may be related to the lower levels of both body dissatisfaction and thin-ideal internalization reported by African American women as compared with European American women. Hispanic American women may have higher levels of binge eating than either European American women or African American women. Asian American women show lower levels of many disordered eating behaviors than European American women. Ethnic minority groups in the United States are less likely than European Americans to seek treatment for eating disorders, suggesting a further need to examine how cultural and ethnic differences relate to differences in eating disorder symptomatology and treatment.
 
Both similarities and differences in disordered eating symptoms have been found across cultures as well. Researchers have found that Japanese women may have levels of body dissatisfaction that are similar to women in the United States; yet there may be different motivations behind body dissatisfaction among Japanese women. For example, body dissatisfaction is largely motivated by the thin-ideal in American culture, while body dissatisfaction may be driven more by a desire for delayed maturation in Japanese culture. In Chinese culture, fear of fatness may play a role in body dissatisfaction similar to American culture.
 
However, such generalizations may be limited by common definitions of cultural and ethnic groups. For example, China is inhabited by 56 different ethnic groups. As was seen when looking at the differences in disordered eating between ethnic groups in the United States, it’s likely that variability exists in levels of disordered eating across ethnic groups in China (and everywhere!). Imprecise definitions of culture or ethnicity can contribute to difficulties in examining similarities and differences across cultures.
 
Eating disorders are the outcome of a complex interaction between a variety of factors, including culture, environmental risk factors, individual differences in personality, and genetic factors. In order to understand how to reduce the distress and impairment that eating disorders cause, it’s important to examine the unique contribution of each of these factors. In so doing, researchers and clinicians can create interventions that best meet the needs of diverse populations.