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How to find inclusive eating disorder treatment in the LGBTQIA+ community

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Finding inclusive and affirming eating disorder treatment for LGBTQIA+ individuals can be a challenge. Many treatment providers are not culturally competent and are ill-equipped to help members of the LGBTQIA+ community. Given the high rates of eating disorders among queer, transgender, and gender-nonconforming people, culturally competent and affirming providers are critical for recovery.

Last updated on 
August 15, 2022
October 27, 2022
In this article

Prevalence of eating disorders in the LGBTQIA+ community

LGBTQIA+ teens and adults are more likely to have eating disorders and exhibit patterns of disordered eating than cisgender and heterosexual people. (1) The same is true for other mental health disorders, such as major depressive disorder, generalized anxiety disorder, and bipolar disorder. Researchers and professionals within the field discuss these disparities within the framework of the minority stress model (MSM), which posits that people from the LGBTQIA+ community experience many stressors, such as: (1)

  • Discrimination
  • Stigma
  • Prejudice
  • Internalized homophobia and transphobia
  • Hiding their gender or sexual identity
  • Expectations of rejection
  • Violence
  • Shame

Research has found that about 54% of LGBTQIA+ teens have been diagnosed with an eating disorder at some point in their lives. An additional 21% of this population has suspected they have an eating disorder, but they haven’t been formally diagnosed. (1)

Adult sexual minorities (gay, bisexual, pansexual, lesbian, etc.) have been found to experience severe eating disorder symptoms, such as binging, purging, desire for thinness, body dissatisfaction, and significant concern about body shape and size. 

Compared to their cisgender peers, transgender adolescents and adults report higher rates of: (1)

  • Fasting for more than 24 hours
  • Diet pill use
  • Laxative use
  • Illicit steroid use
  • Bingeing
  • Purging
  • Restrictive eating

One study found nearly 70% of transgender and gender non-conforming adults reported dissatisfaction in their eating behaviors and over 67% based their self-worth on their weight. (1)

Protective factors

Although LGBTQIA+ individuals experience countless risk factors that increase the likelihood of developing an eating disorder, there are also protective factors for this population as well. These may include: (1)

  • Social support
  • Being in a healthy, stable relationship
  • Self-compassion

Two of these protective factors, social support and self-compassion, are typically integrated into LGBTQIA+ affirming eating disorder treatment. Social support can come in the form of group therapy, group meals, or support group meetings. All of these options give patients the opportunity to share their experiences, learn from others, and have their feelings validated.

And self-compassion is a foundation of eating disorder recovery. Granting yourself the same kindness and forgiveness that you would a loved one is a powerful tool for recovery. It allows you to accept that your journey won’t necessarily be linear.  There may be some ups and downs, and that’s okay. 

Features of an inclusive program

Members of the LGTBQIA community face many barriers to treatment, with one of the major ones being a lack of culturally competent therapists and doctors. And with that barrier comes another: a lack of a safe space for LGBTQIA+ patients. Honesty in treatment is crucial to healing. So queer and trans patients must feel like they are in a safe space where they can share openly about their experiences. 

A safe space

When looking for a quality program for LGBTQIA+ patients, it’s important to know what to look for. For an eating disorder program to truly be inclusive, it has to be more than a physically safe space—it must be an emotionally safe, respectful, compassionate, and affirming space, as well.  

Culturally competent treatment providers

The treatment team must be culturally sensitive and responsive and understand the context of eating disorders within queerness and transness, as well as the unique stressors and challenges for various sub-groups. For example, many trans men may feel significant pressure—both external and internal—to meet traditional masculine body ideals, such as having broad shoulders and narrow hips. Knowing this and understanding why this pressure may lead to an eating disorder in a trans man is crucial to creating a strong therapeutic alliance and bond. 

Additionally, as well as having culturally competent treatment providers, inclusive programs also employ providers who are in the LGBTQIA+ community themselves, which grants them the knowledge of lived experience when treating these patients. Of course, LGBTQIA+ experiences are not ubiquitous, but it is still a helpful starting place.

Affirming language

Culturally competent therapists use language that affirms each patient’s sexual and/or gender identity. They also know the right questions to ask and understand that asking questions is better than making assumptions or avoiding the issue altogether. Examples of affirming language include:

  • Using the correct pronouns
  • Avoiding referring to pronouns as “preferred pronouns” (they are not preferred; they simply are)
  • Avoiding use of the person’s dead name
  • Using gender-neutral language when addressing the group
  • Creating intake forms that don’t assume gender or sexual identity

Awareness of how gender dysphoria affects eating disorders

An inclusive and affirming eating disorder treatment program staffs a treatment team that understands and acknowledges how gender dysphoria can lead to disordered eating symptoms. While body positivity messaging may be beneficial for some people in recovery, it’s important to note that body positivity can be invalidating for trans and nonbinary patients who experience gender dysphoria.

Again, while some treatment programs may celebrate the return of a patient’s period (due to weight restoration), this can be a dysphoric and distressing experience for those who don’t identify as a cis woman. And in the same breath, it’s also vital to understand that every patient is going to feel differently about these things—while one gender nonconforming patient may feel dysphoric, a trans man may be perfectly okay with bleeding. Regardless, inclusive staff members will avoid language that equates menstruation with womanhood, given that people of all genders may have periods. 

Inclusive care for LGBTQIA+ patients at Within Health

At Within Health, we offer inclusive care for transgender, non-binary, queer individuals and beyond. We provide specialized, affirming treatment tailored to meet the needs of every patient who joins our virtual program. Our providers are gender-competent and LGBTQIA+ experienced therapists, physicians, dieticians, and other specialists. They understand the unique challenges and stressors associated with being an LGBTQIA+ identified person.  

We take a patient-centered approach to treatment, which helps to build rapport and trust between our providers and LGBTQIA+ patients. Our eating disorder care is responsive to patient needs, preferences, and values. And we foster a collaborative environment in which every patient is given the power to guide clinical decisions and their treatment plan.

Another barrier to quality eating disorder treatment is geographical. Many people, including transgender and queer individuals, can’t access the care they need because of where they live and the resources available to them. Our virtual program closes that treatment gap, providing members of the LGBTQIA+ community with the much-needed treatment they need to recover from an eating disorder in an environment that is respectful, safe, and compassionate.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Parker, L.L., Harriger, J.A. (2020). Eating Disorders and Disordered Eating Behaviors in the LGBT Population: A Review of the Literature. Journal of Eating Disorders 8 (51). https://doi.org/10.1186/s40337-020-00327-y

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