Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2022 Dec 1.
Published in final edited form as: Eat Behav. 2021 Oct 14;43:101575. doi: 10.1016/j.eatbeh.2021.101575

Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual-and community-level factors

Grace B Jhe a,b,*, Ethan H Mereish c, Allegra R Gordon a,d, Julie M Woulfe e, Sabra L Katz-Wise a,f,g
PMCID: PMC8739806  NIHMSID: NIHMS1752824  PMID: 34757266

Abstract

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (β = 0.15, p = .013) and lower body esteem (β = −0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals’ emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.

Keywords: Bi+, Bisexual, Body esteem, Emotional eating, Minority stress, Anti-bisexual minority stress

1. Introduction

Sexual minority individuals (e.g., lesbian, gay, bisexual, or queer individuals) are often exposed to discrimination, harassment, and marginalization related to their sexual orientation (Littlejohn et al., 2019). The minority stress model (Meyer, 1995; Meyer, 2003) posits that these experiences are stressors that may lead to adverse health outcomes. Heterosexist minority stress (i.e., experiencing discrimination or prejudice based on sexual orientation) specifically has been associated with higher levels of psychological distress (Szymanski, 2006a) and more disordered eating behaviors (Watson et al., 2015; Watson, Velez, Brownfield, Flores, 2016a) among sexual minority women. Experiences of sexual minority stress are associated with more body image concerns (Kimmel, Mahalik, 2005a; Meyer, 2003) and more disordered eating behaviors(Watson et al., 2015; Watson, Velez, Brownfield, Flores, 2016a) in addition to higher levels of psychological distress (Meyer, 1995; Meyer, 2003; Scandurra et al., 2020; Szymanski, 2006a).

In addition to minority stressors that all sexual minority individuals experience (e.g., heterosexist discrimination), bisexual individuals face unique minority stressors related to their bisexual orientation, including anti-bisexual stigma or biphobia, defined as negative attitudes about bisexuality and bisexual individuals (Mulick & Wright, 2002). Anti-bisexual stigma exists in both heterosexual as well as in lesbian and gay communities (Brewster et al., 2014; Chmielewski & Yost, 2013; Mulick & Wright, 2002; Roberts et al., 2015), and bisexual individuals may experience marginalization from both of these communities (Brewster & Moradi, 2010; Roberts et al., 2015). A growing body of research indicates that bisexual individuals are at risk of experiencing increased mental health concerns and a higher prevalence of poor health outcomes compared to both heterosexual and lesbian and gay individuals (Bostwick et al., 2015), possibly as a result of anti-bisexual stigma (Arnett et al., 2019; Dyar & London, 2018; Feinstein et al., 2020; Flanders, Dobinson, Logie, 2017a). In fact, a previous study showed that greater bisexual-specific minority stress was significantly associated with poorer health above and beyond the effects of heterosexist minority stress among individuals with bisexual orientation (Katz-Wise, Mereish, & Woulfe, 2017). However, bisexual individuals are often grouped with other sexual minorities in research instead of being assessed as a unique group (Galupo et al., 2015; Watson, Velez, Brownfield, Flores, 2016a). Incorporating the minority stress model in understanding the impact of bisexual-specific minority stress—in addition to the heterosexist minority stress experiences they share with other sexual minority individuals—can bring to light the unique experiences bisexual individuals have.

1.1. Body image among sexual minority individuals

Body image is a multidimensional construct referring to affect and cognitions related to self-perception of body shape, size, and form (McClain & Peebles, 2016; Ryan et al., 2010). Research on sexual minority men, mostly focused on gay men, has shown that they are more likely than heterosexual men to experience poor body image and related distress (Calzo et al., 2017; Dahlenburg et al., 2020; Feldman & Meyer, 2007; He et al., 2020; Kimmel, Mahalik, 2005b; Morrison et al., 2004; Russell & Keel, 2002). Findings on sexual minority women have been inconsistent (He et al., 2020; Smith et al., 2019), such as significantly higher levels of body acceptance among lesbian and bisexual women than heterosexual women (Dahlenburg et al., 2020; Leavy & Hastings, 2010) or insignificant differences between lesbian and heterosexual women (He et al., 2020; Huxley et al., 2014; Morrison et al., 2004; Yean et al., 2013). Expanding objectification theory (i.e., a framework that argues that increased vulnerability to disordered eating in women is related to having one’s body evaluated and treated as a sexualized object) (Fredrickson & Roberts, 1997), scholars have argued that bisexual women may be particularly at risk for poor body image and eating disorder behaviors due to their exposure to cultural depictions of bisexual people as hypersexual and sexually promiscuous (Doan Van, Mereish, Woulfe, & Katz-Wise, 2019; Flanders, Dobinson, Logie, 2017b; Rust, 2002a; Watson, Velez, Brownfield, Flores, 2016b). Initial research on the relationship between these constructs indicates that sexual orientation-based discrimination and objectification have a salient effect on bisexual women’s body image and body shame (Brewster et al., 2014; Chmielewski & Yost, 2013). A key dimension of body image is body esteem, which refers to the overall positive or negative self-evaluations and feelings towards one’s body or appearance (Franzoi & Shields, 1984; Mendelson et al., 2001). Low body esteem has implications for individuals’ health, psychological well-being, and global self-esteem (Bidzan et al., 2018; Mendelson et al., 2001). Despite the importance of body esteem, how sexual minority individuals may experience global self-evaluations of one’s body remains understudied.

1.2. Eating behaviors among sexual minority individuals

Sexual minority populations have higher rates of disordered eating behaviors, such as binge eating, dieting, and purging, than same-gender heterosexual peers (Calzo et al., 2017; Laska et al., 2015; Shearer et al., 2015; Watson et al., 2017; Yean et al., 2013), although findings among women have been less conclusive (Shearer et al., 2015; Yean et al., 2013). Exposure to sexual minority stress is positively associated with disordered eating behaviors (Katz-Wise et al., 2015; Mason & Lewis, 2015; Watson, Velez, Brownfield, Flores, 2016a). Internalized homophobia (i.e., internalizing society’s negative attitudes about one’s sexual minority identity and directing these attitudes towards oneself) (Barnes & Meyer, 2012), for example, was found to be related to more disordered eating behaviors through body shame as a mediator among sexual minority men (Wiseman & Moradi, 2010). However, less is known about emotional eating, which is the tendency to (over)eat in response to negative emotions (Evers et al., 2010; Frayn & Knäuper, 2018; Lindeman & Stark, 2001; Nguyen-Rodriguez et al., 2009). Emotional eating behavior is associated with stressful events and negative affect (Michels et al., 2012; Tan & Chow, 2014). It is also associated with underlying psychological mechanisms, such as reliance on emotion-oriented coping and avoidance distraction (Spoor et al., 2007), and a lack of adaptive emotion regulation skills (Evers et al., 2010) when experiencing high levels of stress. Individuals who use food to cope with negative mood (e.g., anxiety, depression, stress) may engage in emotional eating and overeating (Evers et al., 2010; Nguyen-Rodriguez et al., 2009). Understanding the unique association between anti-bisexual minority stress and emotional eating will provide insight into bisexual individuals’ experiences.

1.3. A resilience framework for sexual minority individuals

Many sexual minority individuals show resilience despite the stressors they face (Russell, 2005; Saewyc, 2011). Resilience refers to positive adaptation in the context of significant adversity (Luthar et al., 2000; Masten, 2007; Meyer, 2015). There are two types of resilience: individual-based resilience, which focuses on personal agency or qualities that help individuals cope with stress, and community-based resilience, which focuses on connectedness to community and social resources (Meyer, 2015). Many studies with the general population have examined potential protective factors, such as self-compassion, psychological resilience, and family support, that buffer against body esteem or image concerns (Braun et al., 2016; Izydorczyk et al., 2018; Wasylkiw et al., 2012) and emotional eating (Gouveia et al., 2018). However, comparable studies for bi+ individuals are limited.

Two forms of individual-based resilience include identity centrality and identity affirmation. Identity centrality refers to the degree to which individuals feel that a specific aspect of themselves, such as sexual orientation, defines who they are as a person (Earnshaw et al., 2015; Quinn & Earnshaw, 2011). Identity affirmation refers to the degree to which individuals feel a sense of belonging and pride about their identity (Ghavami et al., 2011; Perry et al., 2013). Ethnic identity centrality and affirmation have been frequently examined among ethnic minorities, and studies have demonstrated that these identity processes can be protective against the negative effects of discrimination on self-esteem, depressive symptoms, and school performance (Shramko et al., 2018), and may buffer against the effect of stigma on health (Pascoe & Smart Richman, 2009). Among sexual minority individuals, a sense of affirmation of one’s sexual and ethnic minority identity may promote a positive sense of attachment to the group, which can in turn yield psychological benefits (Ghavami et al., 2011). A potential protective effect of identity centrality has also been shown among sexual minority Latinx youth, such that those with low minority stress and high identity centrality had higher academic performance (Shramko et al., 2018).

Community connectedness is the degree to which an individual feels connected to the sexual and gender minority community (Brandon-Friedman & Kim, 2016; Frost & Meyer, 2012), and has been found to predict positive individual and social outcomes among sexual minorities in a longitudinal study (Frost & Meyer, 2012). Community connectedness can positively impact psychological well-being, promote resilience, and buffer against the effects of minority stress on health among sexual and gender minorities (DiFulvio, 2011; Frost & Meyer, 2012; Hendricks & Testa, 2012). However, little is known about whether these individual- and community-level factors would buffer against disordered eating and body image concerns.

1.4. Purpose of the present study

Applying the minority stress model and a resilience framework, the current study sought to address the limitations in research by examining the associations between bisexual-specific minority stress and body image concerns as well as emotional eating behaviors, while accounting for heterosexist minority stress, among individuals who fall under the “bisexual umbrella.” (Flanders et al., 2017c; Galupo et al., 2017) The study also sought to examine the potential protective role of individual and community factors for those under the bisexual umbrella. Of note, bisexuality has various definitions based on behavior, attraction, or desire and may use binary or nonbinary definitions (Flanders et al., 2017c). In the current study, bisexuality is defined as an umbrella term that refers to individuals with bisexual identity and/or attractions to more than one gender (Doan Van et al., 2019; Mereish, Katz-Wise, & Woulfe, 2017; Mereish, Katz-Wise, & Woulfe, 2017; Bauer & Brennan, 2013; Chmielewski & Yost, 2013; Flanders et al., 2017c; Rust, 2002b), and consequently this study included individuals who self-reported identifying as bisexual, pansexual, and queer individuals, and those who report attractions to more than one gender regardless of identity (hereafter referred to as bi+) (Mereish, Katz-Wise, & Woulfe, 2017; Mereish, Katz-Wise, & Woulfe, 2017). There is a dearth of research on the patterning of anti-bisexual minority stress and related resilience factors across bi+ populations, and the research that exists suggests that there is both significant overlap in experiences of anti-bisexual prejudice as well as some distinct differences for bi-identified people (Mitchell et al., 2015). This study offers a novel opportunity to examine associations between anti-bisexual minority stress and body esteem and emotional eating in a bi+ sample, as well as to examine similarities and differences between plurisexual identities within the bisexual umbrella. Given the unique experiences of adults who identify specifically as bisexual, as detailed above, sensitivity analyses were conducted with this group. Specifically, we hypothesized that individuals who experience higher levels of anti-bisexual minority stress would experience lower body esteem and more emotional eating. We also hypothesized that identity centrality, identity affirmation, and connectedness to the bisexual community would serve as moderators, buffering against the associations between anti-bisexual minority stress on body esteem and emotional eating.

2. Method

2.1. Procedures

Participants for the present study were part of a larger study of bi+ adults’ health and wellbeing (Katz-Wise et al., 2017; Mereish, Katz-Wise, & Woulfe, 2017; Mereish, Katz-Wise, & Woulfe, 2017). They were recruited through online sexual minority and bisexual-specific groups and listservs (e.g., social groups). Inclusion criteria were age 18 years or older and identifying as bisexual and/or having attractions to more than one gender. All potential participants received a link to the data collection website, on which they provided informed consent, completed an online survey, and had the option of being entered into a raffle for a monetary incentive for their participation. The study was approved by the researchers’ Institutional Review Board. More detailed information about the study methods can be found in previous studies (Katz-Wise et al., 2017; Mereish, Katz-Wise, & Woulfe, 2017; Mereish, Katz-Wise, & Woulfe, 2017).

2.2. Participants

Participants were 498 adults ages 18 to 64 years (M = 28.50, SD = 9.59) and were mostly cisgender women (76.7%) and White (79.7%; see Table 1). All participants identified as bisexual and/or reported attraction to more than one gender (and may have had other plurisexual sexual orientation identities). Most participants in the study identified as bisexual (74.8%), followed by queer (16.5%) and pansexual (3.4%); a minority of participants (5.2%) endorsed another sexual orientation identity (e.g., lesbian, gay, heterosexual) and attractions to multiple genders. They reported their education level as follows: some high school or high school degree or GED equivalent (33.1%), Associate or Bachelor’s degree (39.4%), and graduate degree (27.5%). Many participants reported having low income (annual income ≤ $19,999; 56.5%), with 37.6% students and 34.5% working full-time. The mean body mass index (BMI; kg/m2) in the sample was 26.88 (SD = 8.18) and participants were in the following BMI categories: <18.5 (4.8%), 18.5 - <25.0 (48.6%), 25.0 - <30.0 (20.2%), and 30.0 or higher (26.4%).

Table 1.

Sociodemographic characteristics the sample (N = 498).

Total Sample
M (SD) % (n)
Age 28.60 (9.59)
Gender identity
 Cisgender women 76.7 (382)
 Cisgender men 11.2 (56)
 Transgender, binary 2.8 (14)
 Transgender, nonbinary/other (e.g., agender, gender fluid) 9.2 (46)
Sexual Orientation Identity
 Bisexual 74.8 (372)
 Gay 0.6 (3)
 Lesbian 0.4 (2)
 Heterosexual/straight 0.8 (4)
 Queer 16.5 (82)
 Pansexual 3.4 (17)
 Other 3.4 (17)
Race/ethnicity
 Asian/Pacific Islander 2.8 (14)
 Black/African American 2.8 (14)
 Hispanic/Lantina/o 3.8 (19)
 Middle Eastern/Arab American 0.8 (4)
 Native American/American Indian/Alaskan 0.4 (2)
 White (non-Hispanic) 79.7 (397)
 Biracial/Multiracial 7.8 (39)
 Other 1.8 (9)
Education
 High school degree/GED or less 33.1 (165)
 College degree 39.4 (196)
 Graduate degree 27.5 (137)
Individual Income
 ≥ $9999 42.2 (207)
 $10,000 to $19,999 14.3 (70)
 $20,000 to $29,999 12.9 (63)
 $30,000 to $49,999 13.1 (64)
 $50,000 to $69,999 8.2 (40)
 ≥ $70,000 9.4 (46)
Employment
 Full time 34.5 (172)
 Part time 11.4 (57)
 Student 37.6 (187)
 Unemployed 10.4 (52)
 Other 6 (30)
Body Mass Index (BMI) 26.88 (8.18)
 Below 18.5 4.8 (23)
 18.5–24.9 48.6 (235)
 25–29.9 20.2 (98)
 30 or more 26.4 (128)
Open in a new tab

Note. BMI = [weight (kg) / height (m)]2.

2.3. Measures

2.3.1. Sociodemographic variables

Participants’ sexual orientation was assessed with the following options: Bisexual; Gay; Heterosexual/Straight; Lesbian; Queer; Don’t Know; Unsure/Questioning; Other (please specify). Participants’ gender identity was assessed with the following response options: Male/man; Female/woman; Transgender; and Other. Participants’ age, race/ethnicity, education, and annual individual income were also assessed.

2.3.2. BMI

Participants’ BMI was assessed by asking them for their current height and weight in the U.S. Units of Measurement (e.g., feet, inches, and pounds). Participants’ height and weight was converted to the metric system to calculate their BMI, which was computed by dividing weight in pounds by height in inches squared and then multiplying by a conversation factor of 703 (Centers for Disease Control and Prevention, 2012).

2.3.3. Heterosexist minority stress

Heterosexist minority stress was assessed using the 7-item Harassment and Rejection subscale of the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) (Szymanski, 2006b), a validated measure that assesses the frequency of experiencing harassment, rejection, and discrimination in the past year (e.g., “How many times have you been verbally insulted because of you are a lesbian/gay/bisexual person?”). Response options were on a 6-point scale, ranging from 1 (the event has never happened to you) to 6 (the event happened almost all the time [more than 70% of the time). A mean was computed and higher scores indicate higher levels of heterosexist minority stress. For this study, the Cronbach alpha reliability was 0.83.

2.3.4. Anti-bisexual minority stress

Anti-bisexual minority stress was assessed with the previously validated Anti-Bisexual Experiences Scale (Brewster & Moradi, 2010) (e.g., “People have not taken my sexual orientation seriously because I am bisexual”), which measured life experiences of anti-bisexual minority stress or prejudice from heterosexual people (17-items) and from lesbian and gay people (17-items). Response options were on a 6-point scale, ranging from 1 (never) to 6 (almost all of the time). As the two subscales were highly correlated, we computed a mean of both subscales for a combined scale of overall anti-bisexual minority stress. Higher scores indicate higher levels of anti-bisexual minority stressors. For this study, the Cronbach alpha reliability coefficient for the combined scale was 0.98.

2.3.5. Emotional eating

The 5-item Coping subscale of the Motivations to Eat Scale, a validated measure, assessed participants’ emotional eating behaviors (Jackson et al., 2003) (e.g., “How many times would you say you eat as a way to help you cope?”). Response options were on a 5-point scale, ranging from 1 (almost never/never) to 5 (almost always/always). A mean was computed and higher scores indicate more emotional eating. For this study, the Cronbach alpha reliability was 0.92.

2.3.6. Body esteem

The 6-item Appearance Self-Esteem subscale of the State Self-Esteem Scale, a previously validated measure, assessed participants’ self-evaluations of their appearance, such as body and weight, at a given point in time (Heatherton & Polivy, 1991) (e.g., “I feel satisfied with the way my body looks right now”). Response options were on a 5-point scale, ranging from 1 (not at all) to 5 (extremely). A mean was computed and higher scores indicate higher levels of positive body esteem. For this study, the Cronbach alpha reliability was 0.88.

2.3.7. Identity centrality and affirmation

The 5-item Identity Centrality and the 3-item Identity Affirmation subscales of the Lesbian, Gay, and Bisexual Identity Scale (Mohr & Kendra, 2011), a validated measure, assessed participants’ view of their sexual orientation identity as central to their overall identity (e.g., “My sexual orientation is a central part of my identity”) and participants’ affirmation of their sexual orientation identity (e.g., “I am glad to be an LGB person” and “I’m proud to be part of the LGB community”). Response options were on a 6-point scale, ranging from 1 (strongly disagree) to 6 (strongly agree). For this study, the Cronbach alpha reliability was 0.87 for identity centrality and 0.90 for identity affirmation.

2.3.8. Connectedness to the bisexual community

Participants were asked to rate how connected they felt to the bisexual community with one item (“Please rate how connected you feel to the bisexual community”) with a 7-point scale, from 1 (not connected at all) to 7 (very connected). This question was developed by the authors for this study.

2.4. Analytic method

The data were cleaned and screened for missing cases; some had missing data on the item level; however, most had no more than 0.60% item-level missingness, one had no more than 0.80%, and three had no more than 1%, which is considered small (Parent, 2013). We first examined correlations among all the study’s measures. We then tested six separate hierarchical linear regression models to examine the associations between anti-bisexual minority stress and emotional eating as well as body esteem. We accounted for the following covariates on the first step of each regression model: age, gender, education, income, race/ethnicity, BMI, and heterosexist minority stress (Katz-Wise et al., 2017). We entered the main effects of anti-bisexual minority stress, identity centrality, identity affirmation, and connectedness to the bisexual community on the second step for each respective model, and entered the two-way interactions of anti-bisexual minority stress and each of the respective moderators (identity centrality, identity affirmation, and connectedness to the bisexual community) on the third step for each respective model. The criterion variables were emotional eating and body esteem. We centered the anti-bisexual minority stress, identity centrality, identity affirmation, and connectedness to the bisexual community variables. We followed the commonly used procedures for testing moderation (Aiken & West, 1991). Given previous literature suggesting that adults who identify as bisexual experience more anti-bisexual prejudice from lesbian and gay individuals as compared to other bisexual+ identities (e.g., pansexual) (Mitchell et al., 2015), we also conducted sensitivity analyses for the same models specifically focusing on participants who identified as bisexual.

3. Results

Unadjusted correlations are presented in Table 2. We conducted an ANOVA to test for sexual orientation identity differences (bisexual, queer, pansexual, and other sexual orientations) in the experience of anti-bisexual minority stress. A significant difference was found, F (3,496) = 3.953, p = .008, η2 = 0.023. A follow up Bonferroni adjustment demonstrated that bisexual participants (M = 2.71, SD = 1.1) had higher levels of anti-bisexual prejudice compared to participants who were in the “other reported sexual orientations” group (M = 2.03; SD = 0.95; p = .011). There were no significant differences between bisexual, queer (M = 2.53; SD = 0.97), or pansexual (M = 2.39; SD = 0.78) participants.

Table 2.

Correlations among variables in the study and their descriptives.

Anti-bisexual Prej-Comb Heterosexist MS Identity Centrality Identity Affirmation Bi Comm. Connect. Emotional Eating Body Esteem
Anti-bisexual Prej-Comb –
Heterosexist MS 0.581** –
Identity Centrality 0.280** 0.211** –
Identity Affirmation 0.122** 0.057 0.529** –
Bi Community Connectedness 0.160** 0.130** 0.307** 0.298** –
Emotional Eating 0.215** 0.196** 0.089* −0.014 0.077 –
Body Esteem −0.220** −0.244** 0.056 0.179** 0.036 −0.430** –
Mean 2.63 1.72 4.35 4.83 4.09 2.53 3.02
Standard Deviation 1.07 0.71 1.09 1.04 1.89 0.97 0.89
Range 1–6 1–5.14 1.40–6 1–6 1–7 1–5 1–5
Open in a new tab

Note. Anti-bisexual Prej-Comb = Anti-Bisexual Prejudice Scale – from both Heterosexual People and Lesbian and Gay People; Heterosexist MS = heterosexist minority stress; Bi Community Connectedness = Connectedness to the bisexual community.

*

p < .05.

**

p < .01.

Regression analyses for the associations between anti-bisexual minority stress and potential protective factors as well as emotional eating and body esteem are reported in Table 3 (Step 2). Analyses testing the two-way moderating interactions were not significant (reported in Table 3, Step 3). While accounting for sociodemographic variables, BMI, and heterosexist minority stress, anti-bisexual minority stress across all models was associated with more emotional eating (βs = 0.14 to 0.16, ps < 0.05) and lower body esteem (βs = −0.14 to −0.15, ps < 0.05). Identity centrality and affirmation and connectedness to the bisexual community were all associated with a greater body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively), but not with emotional eating.

Table 3.

Results from linear regression analyses on the association between anti-bisexual minority stress and emotional eating and body esteem.

Models Emotional Eating
 Body Esteem
B (SE) β B (SE) β
Step 1
 Age 0.00 (0.01) −0.04 −0.01 (0.01) −0.06
 Gender Identity −0.15 (0.14) −0.05 0.12 (0.12) 0.05
 Race −0.35 (0.11) −0.14** 0.08 (0.10) 0.04
 Education 0.01 (0.11) 0.01 0.07 (0.10) 0.04
 Income −0.10 (0.11) −0.05 0.27 (0.09) 0.15**
 BMI 0.03 (0.01) 0.24*** −0.03 (0.01) −0.30***
 Heterosexist Minority Stress 0.24 (0.06) 0.18*** −0.27 (0.06) −0.22***
R2 = 0.12 R2 = 0.17
Step 2
 Anti-bisexual Prej-Comb 0.14 (0.05) 0.15* −0.12 (0.05) −0.15**
 Identity Centrality 0.01 (0.04) 0.01 0.13 (0.04) 0.16**
R2 = 0.13; Δ R2 = 0.01* R2 = 0.20; Δ R2 = 0.03***
Step 3
 Anti-bisexual Prej-Comb 0.14 (0.05) 0.15* −0.12 (0.05) −0.15*
 Identity Centrality 0.01 (0.04) 0.01 0.13 (0.05) 0.16**
 Anti-bisexual Prej x Centrality 0.00 (0.04) 0.00 −0.01 (0.03) −0.01
R2 = 0.13; Δ R2 = 0.00 R2 = 0.20; Δ R2 = 0.00
Step 2
 Anti-bisexual Prej-Comb 0.14 (0.05) 0.16** −0.12 (0.05)  0.14*
 Identity Affirmation −0.03 (0.04) −0.03 0.18 (0.04) 0.21***
R2 = 0.14; Δ R2 = 0.02 R2 = 0.22; Δ R2 = 0.05***
Step 3
 Anti-bisexual Prej-Comb 0.14 (0.05) 0.16** −0.12 (0.05) −0.14*
 Identity Affirmation −0.03 (0.04) −0.04 0.18 (0.04) 0.21***
 Anti-bisexual Prej x Affirmation −0.03 (0.04) 0.04 0.01 (0.03) 0.02
R2 = 0.14; Δ R2 = 0.00 R2 = 0.22; Δ R2 = 0.00
Step 2
 Anti-bisexual Prej-Comb 0.13 (0.05) 0.15* −0.12 (0.05) −0.14*
 Bi Community Connectedness 0.02 (0.02) 0.03 0.06 (0.02) 0.13**
R2 = 0.13; Δ R2 = 0.02* R2 = 0.19; Δ R2 = 0.02**
Step 3
 Anti-bisexual Prej-Comb 0.13 (0.05) 0.14* −0.11 (0.05) −0.14*
 Bi Community Connectedness 0.02 (0.02) 0.03 0.06 (0.02) 0.13**
 Anti-bisexual Prej x Community 0.02 (0.02) −0.03 −0.02 (0.02) −0.06
R2 = 0.13; Δ R2 = 0.00 R2 = 0.19; Δ R2 = 0.00
Open in a new tab

Note. Anti-bisexual Prej-Comb = Anti-Bisexual Prejudice Scale – from both Heterosexual People and Lesbian and Gay People; Bi Community Connectedness = Connectedness to the bisexual community; BMI = [weight (kg) / height (m)]2; Δ R2 = change in percent variance accounted for between Steps in the model. B = unstandardized beta coefficient; SE = unstandardized error; β = standardized beta coefficient.

*

p < .05.

**

p < .01.

***

p < .001.

Sensitivity analyses for the same models with only participants who identified as bisexual demonstrated largely similar patterns to the models described above. While accounting for sociodemographic variables, BMI, and heterosexist minority stress, anti-bisexual minority stress across all models was associated with more emotional eating (βs = 0.19 to 0.20 ps < 0.01) and lower body esteem (βs = −0.18, ps < 0.01). Identity affirmation and connectedness to the bisexual community were associated with greater body esteem (β = 0.21, p < .001; β = 0.13, p = .004, respectively); however, unlike the prior model, identity centrality was no longer significant (β = 0.10, p = .067). Similar to the original models, identity centrality, affirmation, and connectedness to the bisexual community were not associated with emotional eating; analyses testing the two-way moderating interactions were also not significant.

4. Discussion

A primary aim of this study was to examine the associations between anti-bisexual minority stress and body esteem as well as emotional eating behaviors among bi+ adults. As hypothesized, those who experienced greater anti-bisexual-specific stressors were found to have greater emotional eating and lower body esteem. Although the magnitude of the effect estimates was modest, these associations held, even when accounting for sociodemographic variables, BMI, and heterosexist minority stress, suggesting that greater anti-bisexual minority stress is uniquely associated with bi+ individuals’ greater emotional eating and lower body esteem.

One theory for this finding is that emotional eating serves as a coping strategy for the negative affect associated with discriminatory experiences. This is consistent with affect regulation theories for disinhibited eating (Evers et al., 2010), as well as recent studies including African American and Hispanic/Latino men, which found that general discrimination was positively associated with loss of control eating (Kelly et al., 2020). In fact, the findings from the present study are supported by a previous study, in which cisgender bi+ individuals reported high shape and weight concerns as well as disordered eating behaviors, possibly due to bisexual-specific minority stress (Nagata et al., 2020). Bi+ individuals may experience social exclusion or discrimination from both lesbian and gay individuals as well as heterosexual individuals (Chmielewski & Yost, 2013). Experiencing anti-bisexual prejudice from within a sexual minority community that was expected to be supportive in addition to heterosexual community may heighten internalized biphobia and psychological distress, leading to emotional eating as a way of coping with stress. Moreover, these individuals may also experience low body esteem as a result of low self-esteem – these two constructs are highly associated with one another (Mendelson et al., 1996). Minority stress has been found to be related to lower self-esteem, particularly when individuals of marginalized groups internalize negative stereotypes about their group membership (Austin & Goodman, 2017; Katz et al., 2002). The present study’s findings are consistent with the minority stress model (Meyer, 1995; Meyer, 2003), such that anti-bisexual minority stress serves as a unique stressor that has negative association with the well-being of bi+ individuals who are already at risk of experiencing several stressors, including sexual orientation-based discrimination and objectification (Fredrickson & Roberts, 1997).

Another primary aim of this study was to examine the buffering role of identity centrality, identity affirmation, and connectedness to the bisexual community against the negative effect of anti-bisexual minority stress on body esteem and emotional eating. Results indicated that these three hypothesized moderators did not moderate associations between anti-bisexual prejudice and emotional eating and body esteem. The study showed that the effect of anti-bisexual prejudice did not depend on the level of identity affirmation, identity centrality, or community connectedness. This may underscore the deleterious associations between anti-bisexual minority stress and emotional eating as well as body esteem among bi+ adults given how the main effect of anti-bisexual minority stress was significant above and beyond the interaction effects. However, the moderators demonstrated main effects, such that greater identity affirmation and centrality and community connectedness were associated with more positive body esteem. Variables with main effects or robust and direct ameliorative effects are considered “protective” and are distinguished from interactive or moderating processes that describe under which condition variables have ameliorative effects, such as protective-stabilizing or –enhancing (Luthar et al., 2000). In this resilience framework, identity-level and community-level variables were found to be protective for body esteem above and beyond the effect of anti-bisexual and heterosexist minority stress.

Feeling positive about one’s identity and feeling connected to a bisexual community may protect against sexual orientation-based discrimination and objectification (Brewster et al., 2014; Chmielewski & Yost, 2013), help these individuals externalize anti-bisexual minority stress, and have a positive perception of their bodies. Identity affirmation has been found to have a positive correlation with self-esteem (i.e., feelings about oneself overall), which has also been positively correlated with body esteem (i.e., feelings about one’s body/appearance) (Mendelson et al., 1996). Bi+ individuals with positive feelings about their sexual orientation identity may also feel positive about themselves overall, including their body/appearance. This is consistent with previous studies that found ethnic identity affirmation is positively associated with psychological well-being (Brittian et al., 2013; Ghavami et al., 2011; Perry et al., 2013) and self-esteem (Umaña-Taylor et al., 2008). These findings largely held when the sample was restricted to those who identified as bisexual where greater identity affirmation was associated with higher body esteem. Identity centrality was no longer significant for body esteem, but the trend was still in the same direction (i.e., positive association). This may suggest that the centrality of one’s sexual orientation identity may not be as salient for bisexual individuals specifically, while overall feelings of positivity, belonging, and pride about one’s identity remain important for feelings about one’s body/appearance.

The findings also suggest that a sense of belonging and feeling connected to a bisexual community, in particular, is protective for bi+ individuals in terms of their feelings about their body regardless of their BMI or minority stress. This finding remained the same when the sample included only those who identified as bisexual. This is consistent with previous studies that have demonstrated the protective effects of community connectedness on health outcomes among sexual and gender minorities (DiFulvio, 2011; Frost & Meyer, 2012; Hendricks & Testa, 2012). On the other hand, the hypothesized protective factors were not associated with emotional eating, possibly reflecting a lack of association between one’s sense of identity and emotion regulation strategies or coping skills in context of high stress (Evers et al., 2010; Nguyen-Rodriguez et al., 2009; Spoor et al., 2007). Future research is needed to further explore underlying mechanisms for emotional eating among bi+ individuals.

This research has a number of limitations that should be considered to inform future studies. First, the study design was cross-sectional, limiting the ability to draw causal conclusions. Future research in this area would benefit from using a longitudinal study design to better understand effects of anti-bisexual minority stress on emotional eating and body esteem, as well as underlying mechanisms to describe how individual- and community-level factors contribute to self-perception. Second, the study sample consisted of predominantly White individuals, thereby limiting the generalizability of the findings to other racial and ethnic groups. Third, the study examined community connectedness in relation to the bisexual community using one question. To better understand protective pathways against anti-bisexual minority stress, future studies would benefit from including more questions to also assess connectedness to other communities (e.g., broader LGBT community) and investigating multiple dimensions of community connectedness, such as positivity, closeness, and participation (Frost & Meyer, 2012). Considering that the hypothesized protective factors did not have a significant moderating effect, future research using qualitative methods is needed to better understand the process by which anti-bisexual prejudice is associated with emotional eating and body esteem. Identity affirmation and centrality as well as community connectedness need to be further explored in relation to anti-bisexual minority stress. Finally, the present study did not assess between-group differences in outcomes among different bi+ identities or differences between those with pluriexual identities and those with monosexual identities who report attractions to multiple genders due to insufficient statistical power and a lack of significant findings from sensitivity analyses. However, future research in this area will be helpful in understanding the differences in experiences of anti-bisexual minority stress among individuals who fall under the larger bi+ umbrella. Moreover, examining various dimensions of sexual orientation, including sexual identity, attractions, and behavior, in relation to the experience of sexual minority stress and well-being will be informative as it will better capture the complexity of the construct.

This research has a number of implications for improving clinical practice. It is important for mental health clinicians to assess individuals’ experiences of anti-bisexual discrimination (Brewster et al., 2014) in their clinical practice and consider providing psychoeducation about the relationship between anti-bisexual discrimination, internalized bi-negativity, and the internalization of sociocultural standards and body esteem. It is also necessary for clinicians to assess individual’s feeling of positivity, belonging, and pride about their identity, as identity affirmation is associated with more positive body esteem as well as other forms of resilience. Clinicians should also consider the intersection of oppression of multiple marginalized identities that bi+ individuals experience, such as weight stigma, poverty, sexism, and racism (Rodriguez et al., 2013), and promote skills for coping with stigma and maladaptive minority stress reactions. Although it is beyond the scope of the paper, it is also important to consider intervention strategies for perpetrators of bisexual discrimination.

In summary, the results of the current study underscore the negative associations between anti-bisexual minority stress and emotional eating as well as body esteem, and highlight the protective effect of bi+ identity affirmation and centrality as well as connectedness to a bisexual community on body esteem among bi+ individuals, an understudied population at risk for biphobia from both heterosexual as well as lesbian and gay individuals. Recognizing that bi+ individuals may experience prejudice from both lesbian and gay as well as heterosexual individuals, healthcare providers should pay careful attention to the experience of bisexual-specific minority stress as well as the unique role of identity affirmation when working with bi+ individuals on their eating and body esteem concerns.

Acknowledgements

Dr. Mereish was supported by the NIH/National Institute on Alcohol Abuse and Alcoholism (K08 AA025011). Dr. Katz-Wise was supported by the Maternal and Child Health Bureau, Health Resources and Services Administration (Leadership Education in Adolescent Health project 6T71-MC00009).

Footnotes

CRediT authorship contribution statement

Grace B. Jhe: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. Ethan H. Mereish: Methodology, Visualization, Formal analysis, Writing – review & editing. Allegra Gordon: Conceptualization, Writing – review & editing. Julie M. Woulfe: Conceptualization, Writing – review & editing. Sabra L. Katz-Wise: Conceptualization, Writing – original draft, Writing – review & editing, Supervision.

Declaration of competing interest

None.

References

  1. Aiken LS, & West SG (1991). Thousand Oaks, CA: Sage. [Google Scholar]
  2. Arnett JE III, Frantell KA, Miles JR, & Fry KM (2019). Anti-bisexual discrimination as insidious trauma and impacts on mental and physical health. Psychology of Sexual Orientation and Gender Diversity, 6(4), 475–485. 10.1037/sgd0000344 [DOI] [Google Scholar]
  3. Austin A, & Goodman R (2017). The impact of social connectedness and internalized transphobic stigma on self-esteem among transgender and gender non-conforming adults. Journal of Homosexuality, 64(6), 825–841. 10.1080/00918369.2016.1236587 [DOI] [PubMed] [Google Scholar]
  4. Barnes DM, & Meyer IH (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82(4), 505. 10.1111/j.1939-0025.2012.01185.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bauer GR, & Brennan DJ (2013). The problem with ‘behavioral bisexuality’: Assessing sexual orientation in survey research. Journal of Bisexuality, 13(2), 148–165. 10.1080/15299716.2013.782260 [DOI] [Google Scholar]
  6. Bidzan M, Yousaf O, Lipowski M, & Lipowska M (2018). How health-related behaviors predict body-esteem in men. American Journal of Men’s Health, 12(6), 1901–1907. 10.1177/1557988318801634 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bostwick WB, Hughes TL, & Everett B (2015). Health behavior, status, and outcomes among a community-based sample of lesbian and bisexual women. LGBT Health, 2(2), 121–126. 10.1089/lgbt.2014.0074 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Brandon-Friedman RA, & Kim HW (2016). Using social support levels to predict sexual identity development among college students who identify as a sexual minority. Journal of Gay & Lesbian Social Services, 28(4), 292–316. 10.1080/10538720.2016.1221784 [DOI] [Google Scholar]
  9. Braun TD, Park CL, & Gorin A (2016). Self-compassion, body image, and disordered eating: A review of the literature. Body Image, 17, 117–131. 10.1016/j.bodyim.2016.03.003 [DOI] [PubMed] [Google Scholar]
  10. Brewster ME, & Moradi B (2010). Perceived experiences of anti-bisexual prejudice: Instrument development and evaluation. Journal of Counseling Psychology, 57(4), 451–468. 10.1037/a0021116 [DOI] [Google Scholar]
  11. Brewster ME, Velez BL, Esposito J, Wong S, Geiger E, & Keum BT (2014). Moving beyond the binary with disordered eating research: A test and extension of objectification theory with bisexual women. Journal of Counseling Psychology, 61(1), 50–62. 10.1037/a0034748 [DOI] [PubMed] [Google Scholar]
  12. Brittian AS, Umaña-Taylor AJ, Lee RM, Zamboanga BL, Kim SY, Weisskirch RS Brown EJ, … (2013). The moderating role of centrality on associations between ethnic identity affirmation and ethnic minority college students’ mental health. Journal of American College Health, 61(3), 133–140. 10.1080/07448481.2013.773904 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Calzo JP, Blashill AJ, Brown TA, & Argenal RL (2017). Eating disorders and disordered weight and shape control behaviors in sexual minority populations. Current Psychiatry Reports, 19(8), 49. 10.1007/sll920-017-0801-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Centers for Disease Control and Prevention. (2012). Adult overweight and obesity. Retrieved from: http://www.cdc.gov/obesity/adult/index.html.
  15. Chmielewski JF, & Yost MR (2013). Psychosocial influences on bisexual women’s body image: Negotiating gender and sexuality. Psychology of Women Quarterly, 37(2), 224–241. 10.1177/0361684311426126 [DOI] [Google Scholar]
  16. Dahlenburg SC, Gleaves DH, Hutchinson AD, & Coro DG (2020). Body image disturbance and sexual orientation: An updated systematic review and meta-analysis. Body Image, 35, 126–141. 10.1016/j.bodyim.2020.08.009 [DOI] [PubMed] [Google Scholar]
  17. DiFulvio GT (2011). Sexual minority youth, social connection and resilience: From personal struggle to collective identity. Social Science & Medicine, 72(10), 1611–1617. 10.1016/j.socscimed.2011.02.045 [DOI] [PubMed] [Google Scholar]
  18. Doan Van EE, Mereish EH, Woulfe JM, & Katz-Wise SL (2019). Perceived discrimination, coping mechanisms, and effects on health in bisexual and other non-monosexual adults. Archives of Sexual Behavior, 48(1), 159–174. 10.1007/s10508-018-1254-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Dyar C, & London B (2018). Longitudinal examination of a bisexual-specific minority stress process among bisexual cisgender women. Psychology of Women Quarterly, 42 (3), 342–360. [Google Scholar]
  20. Earnshaw VA, Lang SM, Lippitt M, Jin H, & Chaudoir SR (2015). HIV stigma and physical health symptoms: Do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS and Behavior, 19(1), 41–49. 10.1007/s10461-014-0758-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Evers C, Marijn Stok F, & de Ridder DT (2010). Feeding your feelings: Emotion regulation strategies and emotional eating. Personality and Social Psychology Bulletin, 36(6), 792–804. 10.1177/0146167210371383 [DOI] [PubMed] [Google Scholar]
  22. Feinstein BA, Xavier Hall CD, Dyar C, & Davila J (2020). Motivations for sexual identity concealment and their associations with mental health among bisexual, pansexual, queer, and fluid (bi+) individuals. Journal of Bisexuality, 1–18. 10.1080/15299716.2020.1743402 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Feldman MB, & Meyer IH (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3), 218–226. 10.1002/eat.20360 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Flanders CE, Dobinson C, & Logie C (2017). Young bisexual women’s perspectives on the relationship between bisexual stigma, mental health, and sexual health: A qualitative study. Critical Public Health, 27(1), 75–85. 10.1080/09581596.2016.1158786 [DOI] [Google Scholar]
  25. Flanders CE, Dobinson C, & Logie C (2017). Young bisexual women’s perspectives on the relationship between bisexual stigma, mental health, and sexual health: A qualitative study. Critical Public Health, 27(1), 75–85. 10.1080/09581596.2016.1158786 [DOI] [Google Scholar]
  26. Flanders CE, LeBreton ME, Robinson M, Bian J, & Caravaca-Morera JA (2017). Defining bisexuality: Young bisexual and pansexual people’s voices. Journal of Bisexuality, 17(1), 39–57. 10.1080/15299716.2016.1227016 [DOI] [Google Scholar]
  27. Franzoi S, & Shields S (1984). The body esteem scale: Multidimensional structure and sex differences in a college population. Journal of Personality Assessment, 48(2), 173–178. 10.1207/sl5327752jpa4802_12 [DOI] [PubMed] [Google Scholar]
  28. Frayn M, & Knäuper B (2018). Emotional eating and weight in adults: A review. Current Psychology, 37(4), 924–933. 10.1007/sl2144-017-9577-9 [DOI] [Google Scholar]
  29. Fredrickson BL, & Roberts TA (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21(2), 173–206. 10.1111/j.1471-6402.1997.tb00108.x [DOI] [Google Scholar]
  30. Frost DM, & Meyer IH (2012). Measuring community connectedness among diverse sexual minority populations. Journal of Sex Research, 49(1), 36–49. 10.1080/00224499.2011.565427 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Galupo MP, Mitchell RC, & Davis KS (2015). Sexual minority self-identification: Multiple identities and complexity. Psychology of Sexual Orientation and Gender Diversity, 2, 355–364. 10.1037/sgd0000131 [DOI] [Google Scholar]
  32. Galupo MP, Ramirez JL, & Pulice-Farrow L (2017). “Regardless of their gender”: Descriptions of sexual identity among bisexual, pansexual, and queer identified individuals. Journal of Bisexuality, 17(1), 108–124. 10.1080/15299716.2016.1228491 [DOI] [Google Scholar]
  33. Ghavami N, Fingerhut A, Peplau LA, Grant SK, & Wittig MA (2011). Testing a model of minority identity achievement, identity affirmation, and psychological well-being among ethnic minority and sexual minority individuals. Cultural Diversity and Ethnic Minority Psychology, 17(1), 79–88. 10.1037/a0022532 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Gouveia MJ, Canavarro MC, & Moreira H (2018). Is mindful parenting associated with adolescents’ emotional eating? The mediating role of adolescents’ self-compassion and body shame. Frontiers in Psychology, 9, 2004. 10.3389/fpsyg.2018.02004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. He J, Sun S, Lin Z, & Fan X (2020). Body dissatisfaction and sexual orientations: A quantitative synthesis of 30 years research findings. Clinical Psychology Review, 101896. 10.1016/j.cpr.2020.101896 [DOI] [PubMed] [Google Scholar]
  36. Heatherton TF, & Polivy J (1991). Development and validation of a scale for measuring state self-esteem. Journal of Personality and Social psychology, 60(6), 895–910. 10.1037/0022-3514.60.6.895 [DOI] [Google Scholar]
  37. Hendricks ML, & Testa RJ (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467. 10.1037/a0029597 [DOI] [Google Scholar]
  38. Huxley CJ, Clarke V, & Halliwell E (2014). A qualitative exploration of whether lesbian and bisexual women are ‘protected’ from sociocultural pressure to be thin. Journal of Health Psychology, 19(2), 273–284. 10.1177/1359105312468496 [DOI] [PubMed] [Google Scholar]
  39. Izydorczyk B, Kwapniewska A, Lizinczyk S, & Sitnik-Warchulska K (2018). Psychological resilience as a protective factor for the body image in post-mastectomy women with breast cancer. International Journal of Environmental Research and Public Health, 15(6), 1181–1196. 10.3390/ijerphl5061181 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Jackson B, Cooper ML, Mintz L, & Albino A (2003). Motivations to eat: Scale development and validation. Journal of Research in Personality, 37(4), 297–318. 10.1016/S0092-6566(02)00574-3 [DOI] [Google Scholar]
  41. Katz J, Joiner TE, & Kwon P (2002). Membership in a devalued social group and emotional well-being: Developing a model of personal self-esteem, collective self-esteem, and group socialization. Sex Roles, 47(9), 419–431. 10.1023/A:1021644225878 [DOI] [Google Scholar]
  42. Katz-Wise SL, Mereish EH, & Woulfe J (2017). Associations of bisexual-specific minority stress and health among cisgender and transgender adults with bisexual orientation. Journal of Sex Research, 54, 899–910. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Katz-Wise SL, Scherer EA, Calzo JP, Sarda V, Jackson B, Haines J, & Austin SB (2015). Sexual minority stressors, internalizing symptoms, and unhealthy eating behaviors in sexual minority youth. Annals of Behavioral Medicine, 49(6), 839–852. 10.1007/sl2160-015-9718-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Kelly NR, Cotter EW, Guidinger C, & Williamson G (2020). Perceived discrimination, emotion dysregulation and loss of control eating in young men. Eating Behaviors, 37, Article 101387. 10.1016/j.eatbeh.2020.101387 [DOI] [PubMed] [Google Scholar]
  45. Kimmel SB, & Mahalik JR (2005). Body image concerns of gay men: The roles of minority stress and conformity to masculine norms. Journal of Consulting and Clinical Psychology, 73(6), 1185–1190. 10.1037/0022-006X.73.6.1185 [DOI] [PubMed] [Google Scholar]
  46. Kimmel SB, & Mahalik JR (2005). Body image concerns of gay men: The roles of minority stress and conformity to masculine norms. Journal of Consulting and Clinical Psychology, 73(6), 1185–1190. 10.1037/0022-006X.73.6.1185 [DOI] [PubMed] [Google Scholar]
  47. Laska MN, VanKim NA, Erickson DJ, Lust K, Eisenberg ME, & Rosser BS (2015). Disparities in weight and weight behaviors by sexual orientation in college students. American Journal of Public Health, 105(1), 111–121. 10.2105/AJPH.2014.302094 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Leavy P, & Hastings L (2010). Body image and sexual identity: An interview study with lesbian, bisexual and heterosexual college age-women. Electronic Journal of Human Sexuality, 13. http://www.ejhs.org/volume13/bodyimage.htm. [Google Scholar]
  49. Lindeman M, & Stark K (2001). Emotional eating and eating disorder psychopathology. Eating Disorders, 9(3), 251–259. 10.1080/10640260127552 [DOI] [PubMed] [Google Scholar]
  50. Littlejohn T, Poteat T, & Beyrer C (2019). Sexual and gender minorities, public health, and ethics. The Oxford Handbook of Public Health Ethics, 232–246. 10.1093/oxfordhb/9780190245191.013.17. [DOI] [Google Scholar]
  51. Luthar SS, Cicchetti D, & Becker B (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. 10.llll/1467-8624.00164 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Mason TB, & Lewis RJ (2015). Minority stress and binge eating among lesbian and bisexual women. Journal of Homosexuality, 62(7), 971–992. 10.1080/00918369.2015.1008285 [DOI] [PubMed] [Google Scholar]
  53. Masten AS (2007). Resilience in developing systems: Progress and promise as the fourth wave rises. Development and Psychopathology, 19(3), 921–930. 10.1017/S0954579407000442 [DOI] [PubMed] [Google Scholar]
  54. McClain Z, & Peebles R (2016). Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics, 63(6), 1079–1090. 10.1016/j.pci.2016.07.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Mendelson BK, Mendelson MJ, & White DR (2001). Body-esteem scale for adolescents and adults. Journal of Personality Assessment, 76(1), 90–106. 10.1207/S15327752JPA7601_6 [DOI] [PubMed] [Google Scholar]
  56. Mendelson BK, White DR, & Mendelson MJ (1996). Self-esteem and body esteem: Effects of gender, age, and weight. Journal of Applied Developmental Psychology, 17 (3), 321–346. 10.1016/S0193-3973(96)90030-l [DOI] [Google Scholar]
  57. Mereish EH, Katz-Wise SL, & Woulfe J (2017). We’re here and we’re queer: Sexual orientation and sexual fluidity differences between bisexual and queer women. Journal of Bisexuality, 17, 125–139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Mereish EH, Katz-Wise SL, & Woulfe J (2017). Bisexual-specific minority stressors, psychological distress, and suicidality in bisexual individuals: The mediating role of loneliness. Prevention Science, 18(6), 716–725. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Meyer IH (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. 10.2307/2137286 [DOI] [PubMed] [Google Scholar]
  60. Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. 10.1037/0033-2909.129.5.674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Meyer IH (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209–213. 10.1037/sgd0000132 [DOI] [Google Scholar]
  62. Michels N, Sioen I, Braet C, Eiben G, Hebestreit A, Huybrechts I, Vanaelst B, Vyncke K, & De Henauw S (2012). Stress, emotional eating behaviour and dietary patterns in children. Appetite, 59(3), 762–769. 10.1016/j.appet.2012.08.010 [DOI] [PubMed] [Google Scholar]
  63. Mitchell RC, Davis KS, & Galupo MP (2015). Comparing perceived experiences of prejudice among self-identified plurisexual individuals. Psychology & Sexuality, 6(3), 245–257. 10.1080/19419899.2014.940372 [DOI] [Google Scholar]
  64. Mohr JJ, & Kendra MS (2011). Revision and extension of a multidimensional measure of sexual minority identity: The lesbian, gay, and bisexual identity scale. Journal of Counseling Psychology, 58(2), 234–245. 10.1037/a0022858 [DOI] [PubMed] [Google Scholar]
  65. Morrison MA, Morrison TG, & Sager CL (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women?: A meta-analytic review. Body Image, 1(2), 127–138. 10.1016/j.bodyim.2004.01.002 [DOI] [PubMed] [Google Scholar]
  66. Mulick PS, & Wright LW Jr. (2002). Examining the existence of biphobia in the heterosexual and homosexual populations. Journal of Bisexuality, 2(4), 45–64. 10.1300/J159v02n04_03 [DOI] [Google Scholar]
  67. Nagata JM, Compte EJ, Murray SB, Schauer R, Pak E, Flentje A, Capriotti MR, Lubensky ME, Lunn MR, & Obedin-Maliver J (2020). Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 1–13. 10.1007/s40519-020-01070-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Nguyen-Rodriguez ST, Unger JB, & Spruijt-Metz D (2009). Psychological determinants of emotional eating in adolescence. Eating Disorders, 17(3), 211–224. 10.1080/10640260902848543 [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Parent MC (2013). Handling item-level missing data: Simpler is just as good. The Counseling Psychologist, 41(4), 568–600. 10.1177/0011000012445176 [DOI] [Google Scholar]
  70. Pascoe EA, & Smart Richman L (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554. 10.1037/a0016059 [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Perry BL, Stevens-Watkins D, & Oser CB (2013). The moderating effects of skin color and ethnic identity affirmation on suicide risk among low-SES African American women. Race and Social Problems, 5(1), 1–14. 10.1007/si2552-012-9080-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Quinn DM, & Earnshaw VA (2011). Understanding concealable stigmatized identities: The role of identity in psychological, physical, and behavioral outcomes. Social Issues and Policy Review, 5(1), 160–190. 10.1111/j.1751-2409.2011.01029.x [DOI] [Google Scholar]
  73. Roberts TS, Horne SG, & Hoyt WT (2015). Between a gay and a straight place: Bisexual individuals’ experiences with monosexism. Journal of Bisexuality, 15(4), 554–569. 10.1080/15299716.2015.1111183 [DOI] [Google Scholar]
  74. Rodriguez EM, Lytle MC, & Vaughan MD (2013). Exploring the intersectionality of bisexual, religious/spiritual, and political identities from a feminist perspective. Journal of Bisexuality, 13(3), 285–309. 10.1080/15299716.2013.813001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Russell CJ, & Keel PK (2002). Homosexuality as a specific risk factor for eating disorders in men. International Journal of Eating Disorders, 31(3), 300–306. 10.1002/eat.10036 [DOI] [PubMed] [Google Scholar]
  76. Russell ST (2005). Beyond risk: Resilience in the lives of sexual minority youth. Journal of Gay & Lesbian Issues in Education, 2(3), 5–18. 10.1300/J367v02n03_02 [DOI] [Google Scholar]
  77. Rust PCR (2002). Bisexuality: The state of the union. Annual Review of Sex Research, 13(1), 180–240. [PubMed] [Google Scholar]
  78. Rust PCR (2002). Bisexuality: The state of the union. Annual Review of Sex Research, 13(1), 180–240. [PubMed] [Google Scholar]
  79. Ryan TA, Morrison TG, & McDermott DT (2010). Body image investment among gay and bisexual men over the age of 40: A test of social comparison theory and threatened masculinity theory. Gay and Lesbian Issues and Psychology Review, 6(1), 4–19. [Google Scholar]
  80. Saewyc EM (2011). Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience. Journal of Research on Adolescence, 21(1), 256–272. 10.llll/j.1532-7795.2010.00727.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Scandurra C, Pennasilico A, Esposito C, Mezza F, Vitelli R, Bochicchio V, Maldonato NM, & Amodeo AL (2020). Minority stress and mental health in Italian bisexual people. Social Sciences, 9(4), 46. 10.3390/socsci9040046 [DOI] [Google Scholar]
  82. Shearer A, Russon J, Herres J, Atte T, Kodish T, & Diamond G (2015). The relationship between disordered eating and sexuality amongst adolescents and young adults. Eating Behaviors, 19, 115–119. 10.1016/j.eatbeh.2015.08.001 [DOI] [PubMed] [Google Scholar]
  83. Shramko M, Toomey RB, & Anhalt K (2018). Profiles of minority stressors and identity centrality among sexual minority Latinx youth. American Journal of Orthopsychiatry, 88(4), 471–482. 10.1037/ort0000298 [DOI] [PMC free article] [PubMed] [Google Scholar]
  84. Smith ML, Telford E, & Tree JJ (2019). Body image and sexual orientation: The experiences of lesbian and bisexual women. Journal of Health Psychology, 24(9), 1178–1190. 10.1177/1359105317694486 [DOI] [PubMed] [Google Scholar]
  85. Spoor ST, Bekker MH, Van Strien T, & van Heck GL (2007). Relations between negative affect, coping, and emotional eating. Appetite, 48(3), 368–376. 10.1016/j.appet.2006.10.005 [DOI] [PubMed] [Google Scholar]
  86. Szymanski DM (2006). Does internalized heterosexism moderate the link between heterosexist events and lesbians’ psychological distress? Sex Roles, 54(3–4), 227–234. 10.1007/sl1199-006-9340-4 [DOI] [Google Scholar]
  87. Szymanski DM (2006). Does internalized heterosexism moderate the link between heterosexist events and lesbians’ psychological distress? Sex Roles, 54, 227–234. 10.1007/sl1199-006-9340-4 [DOI] [Google Scholar]
  88. Tan CC, & Chow CM (2014). Stress and emotional eating: The mediating role of eating dysregulation. Personality and Individual Differences, 66, 1–4. 10.1016/j.paid.2014.02.033 [DOI] [Google Scholar]
  89. Umaña-Taylor AJ, Vargas-Chanes D, Garcia CD, & Gonzales-Backen M (2008). A longitudinal examination of latino adolescents’ ethnic identity, coping with discrimination, and self-esteem. The Journal of Early Adolescence, 28(1), 16–50. 10.1177/0272431607308666 [DOI] [Google Scholar]
  90. Wasylkiw L, MacKinnon AL, & MacLellan AM (2012). Exploring the link between self-compassion and body image in university women. Body Image, 9(2), 236–245. 10.1016/j.bodyim.2012.01.007 [DOI] [PubMed] [Google Scholar]
  91. Watson LB, Grotewiel M, Farrell M, Marshik J, & Schneider M (2015). Experiences of sexual objectification, minority stress, and disordered eating among sexual minority women. Psychology of Women Quarterly, 39(4), 458–470. [Google Scholar]
  92. Watson LB, Velez BL, Brownfield J, & Flores MJ (2016). Minority stress and bisexual women’s disordered eating: The role of maladaptive coping. The Counseling Psychologist, 44(8), 1158–1186. 10.1177/0011000016669233 [DOI] [Google Scholar]
  93. Watson LB, Velez BL, Brownfield J, & Flores MJ (2016). Minority stress and bisexual women’s disordered eating: The role of maladaptive coping. The Counseling Psychologist, 44(8), 1158–1186. 10.1177/0011000016669233 [DOI] [Google Scholar]
  94. Watson RJ, Adjei J, Saewyc E, Homma Y, & Goodenow C (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders, 50(1), 22–31. 10.1002/eat.22576 [DOI] [PMC free article] [PubMed] [Google Scholar]
  95. Wiseman MC, & Moradi B (2010). Body image and eating disorder symptoms in sexual minority men: A test and extension of objectification theory. Journal of Counseling Psychology, 57(2), 154–166. 10.1037/a0018937 [DOI] [PubMed] [Google Scholar]
  96. Yean C, Benau E, Dakanalis A, Hormes JM, Perone J, & Timko A (2013). The relationship of sex and sexual orientation to self-esteem, body shape satisfaction, and eating disorder symptomatology. Frontiers in Psychology, 4, 887–898. 10.3389/fpsyg.2013.00887 [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES