Understanding eating disorders in the LGBTQIA+ population
LGBTQIA+ stands for lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and the plus represents other identities that are not clearly denoted in the acronym.
The gender identities and sexual orientations included in the LGBTQIA+ acronym are not an exhaustive list, and this community encompasses a wide variety of identities. While this population is very diverse, there are important shared experiences common to many LGBTQIA+ individuals. Although research on eating disorders in LGBTQIA+ communities was not initiated until fairly recently, existing studies have consistently shown that LGBTQIA+ people are more likely to develop eating disorder symptoms than their cisgender, heterosexual peers.1
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Part of this discrepancy has been attributed to the additional stress many LGBTQIA+ people feel from social stigma, prejudice, or discrimination directed at their sexual orientation, gender identity, and sex trait variations.1
Internalized homophobia or transphobia may cause additional stress that can contribute to disordered eating, along with related shame. Individuals who feel pressure to conceal their sexuality or gender identity experience even more challenges and stressors. LGBTQIA+ people also report experiencing more violent incidents and have higher rates of depression, which may also contribute to the development of an eating disorder.1
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LGBTQIA+ eating disorder stats & trends
While research into eating disorder prevalence in the LGBTQIA+ community was not conducted until fairly recently, some patterns are already starting to emerge from the results.
According to one study published in 2019:1,3,4
- Weight-based self-worth was much higher in lesbian women (82%) than in gay men (63%)
- 69.8% of transgender non-conforming adults reported dissatisfaction with eating patterns
- Gay men had the lowest percentage of dissatisfaction with eating patterns, at 47.7%
- 42% of men diagnosed with an eating disorder identify as gay or bisexual
- Lesbian women experience binge eating at higher rates than heterosexual women
Collectively, lesbian, gay, and bisexual individuals, transgender individuals, and other members of the LGBTQIA+ community self-report a higher lifetime prevalence of eating disorders than their heterosexual peers, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).5
Eating disorder risk factors for the LGBTQIA+ community
In addition to minority stress and the violence and discrimination that often accompanies it, individuals in the LGBTQIA+ community face additional risk factors for developing eating disorders.
Mental health conditions like depression and anxiety are also common among LGBTQIA+ people. Transgender individuals are at a particularly high risk for experiencing depressive symptoms. (6) Depression and anxiety often co-occur with eating disorders and may play a role in instigating or maintaining them.7
Transgender individuals may face additional internal and external pressures to conform to gendered body ideals,5 which can include the expectation for women to be thin, for men to be muscular, and for nonbinary people to have a curveless body. Attempting to conform to these gendered body ideals is a prevalent factor in the high rates of eating disorder development in transgender and nonbinary populations.1,5
Additional risk factors for LGBTQIA+ people for eating disorders include:3
- A low sense of belonging
- Social stigma and discrimination
- More frequent bullying
- Rejection due to gender and/or sexual orientation
- Childhood or adulthood trauma or violence
Treatment for LGBTQIA+ people with eating disorders
Eating disorders have a negative impact on everyone who experiences them, regardless of sexual orientation or gender identity. It is, therefore, crucially important to provide inclusive care programs that support and fully understand individual challenges experienced by LGBTQIA+ people with eating disorders.
An integrated approach to eating disorder treatment ensures that each patient’s unique needs and challenges are addressed, increasing the likelihood of healing. Patient-centered approaches to care can additionally help build the trust and rapport necessary to ensure LGBTQIA+ patients achieve better overall outcomes.
Different approaches may be used to support LGBTQIA+ patients with eating disorders depending on their needs and circumstances.
Individual psychotherapy
Physicians, psychotherapists, and dietitians routinely provide individualized care for patients with eating disorders.
Individual psychotherapy can be beneficial to individuals receiving outpatient eating disorder support or within higher levels of care.
Therapy may include
cognitive behavioral therapy (CBT), compassion-focused therapy, enhanced cognitive behavioral therapy (CBT-e), or interpersonal psychotherapy (IPT), among many others. Compassion-focused therapy has also been identified as a potentially beneficial approach for transgender and gender non-conforming people.
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Group therapy
Attending
group therapy sessions may be beneficial for some individuals healing from eating disorders. Led by one or several therapists, these sessions involve groups of people addressing distressing thoughts and behaviors together. Doing so as a group can help expand perspectives and help people relate to different aspects of their experiences and needs.
These sessions can be particularly helpful for LGBTQIA+ individuals. Supportive group therapy sessions can provide safe spaces for people who may feel ostracized, bullied, or otherwise targeted to meet with others who have gone through similarly challenging experiences. Group therapy can also be powerful in creating space for someone to feel safe embracing their authentic self while feeling a sense of belonging and connection.
Group sessions can be led by a professional therapist experienced in both working with LGBTQIA+ populations and eating disorders. They can be specific to certain groups within the LGBTQIA+ community, such as gay and bisexual men or transgender people, or be offered for all people identifying as LGBTQIA+.
Telemedicine
Telemedicine has grown in popularity over the past decade, and it may be promising for the treatment of many conditions, including eating disorders.
Research has shown that Internet-based treatment options are effective for patients with eating disorders. As part of living authentically, some transgender and nonbinary people utilize gender-affirming healthcare services.
ender-affirming care (GAC) can be an important part of healing from an eating disorder and building a more positive relationship with oneself, and accessing this type of care through telemedicine can be important for transgender and nonbinary people who would not otherwise have access to local resources.8
Additional treatment considerations
Appropriately tailored approaches to treatment are essential for all individuals with eating disorders, but individualized care is especially for LGBTQIA+ individuals.3
Some LGBTQIA+ patients who have participated in treatment programs for eating disorders have reported feeling disappointed by their providers’ incompetence or ignorance of LGBTQIA+ experiences.9 Without proper training, many clinicians are ill-equipped to help these patients navigate the additional stressors they experience while navigating the world and treatment settings as LGBTQIA+ individuals. It is, therefore, essential to make sure that all providers involved in eating disorder care have appropriate training in working with LGBTQIA+ patient populations.
Treatment programs for LGBTQIA+ people should also include elements relating to body acceptance, including the ways in which sexual orientation, gender identity, and intersex status can impact body image in unique ways for these populations.
Finding help at Within Health
At Within Health, we work to train all of our clinicians on the experiences and concerns of all people, including members of the LGBTQIA+ community. We are always working internally to raise awareness among our staff and be the best providers possible for all of our clients.
Our treatment program is entirely online, through our app and website, giving members of the LGBTQIA+ community access to specialized care when they may otherwise live far from in-person options for this type of treatment.
Our team of multidisciplinary experts develops treatment plans tailored to each patient's specific history and needs, helping to ensure anyone who uses our service is given the best tools possible to succeed.
If you or someone you love in the LGBTQIA+ community is struggling with an eating disorder, help them get connected to a gender-competent program or provider, like Within Health, who has experience working with sexual minority populations.
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