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How social discrimination can lead to eating disorders in trans and queer populations

Belonging to the LGBTQIA+ community can be a source of pride and strength for many people. At the same time, it’s important to acknowledge how social discrimination, including homophobia and transphobia, can negatively impact the mental health of LGBTQIA+ individuals.

These negative impacts include an increased risk of developing psychiatric issues like depression, anxiety disorders, suicidality, post-traumatic stress disorder (PTSD), substance use disorders, and eating disorders.1

Last updated on 
February 13, 2024
Effects of transgender discrimination
In this article

Different types of homophobia and transphobia

Before exploring the effects of social discrimination on mental health, it’s helpful to explore what precisely social discrimination is concerning the LGBTQIA+ community

Transphobia and homophobia can manifest in many different ways, including on structural, systemic, and interpersonal levels.

Structural discrimination

Structural discrimination is imposed through laws, cultural norms, and policies restricting access to various resources.

Examples of structural stigma and discrimination faced by the LGBTQIA+ community include:

  • Refusing housing to queer or transgender individuals
  • Not hiring someone due to their gender or sexual orientation
  • Refusing to provide gender-affirming care
  • The “Walking While Trans” law, which disproportionately targets trans women of color14
  • Inadequate or non-existent insurance coverage for gender-affirming care and family planning services for queer and trans folks
  • Bills requiring trans and nonbinary youth athletes to play with their assigned sex at birth
  • Lack of access to public bathrooms

Structural discrimination can result in a lack of access to essential resources and can have detrimental effects on the lives of LGBTQIA+ people. These can include homelessness or lack of stable housing, untreated medical conditions, legal complications, financial difficulties, and mental health risks.

Interpersonal discrimination

In addition to structural discrimination, LGTBQ individuals also often face transphobia and homophobia on an interpersonal level. This type of discrimination is connected to societal beliefs, norms, and biases.

Interpersonal discrimination may include:

  • Verbal harassment
  • Sexual assault due to gender or sexual orientation
  • Physical violence
  • Bullying
  • Microaggressions, such as using the incorrect name or pronouns
  • Social exclusion at school or work
  • Familial rejection
  • Mistreatment in the healthcare setting
  • Stereotyping

These are just a few examples of the many types of social discrimination transgender and queer people experience. Again, these types of experiences can contribute to the increased risk of developing psychiatric conditions.

The harmful effects of homophobia and transphobia

Many LGTBQ individuals experience harassment, familial rejection, discrimination, excommunication from religious groups, and denial of basic human and civil rights, all of which can contribute to mental health conditions.

A common framework for understanding the effects of transphobia and homophobia on psychological and physical health is the minority stress model. This schema explains how discrimination, stigma, and prejudice can create a stressful and hostile environment, which may contribute to the development of psychiatric issues.2 

Researchers have established three underlying principles of minority stress:2

  • It is unique to marginalized individuals but adds to general everyday stressors.
  • It is chronic or ongoing and related to underlying cultural and social influences, beliefs, or practices.
  • It is socially based, meaning it is caused by structures and social processes rather than individual experiences.

Minority stress can also lead to internalized transphobia and homophobia. This occurs when people view themselves in a negative light due to the influence of cultural stigmas about their sexual orientation or gender. 

Internalized stigma can put a strain on someone’s mental health, even in the absence of negative external events. Strong cultural, familial, or social influences on people, plus their exposure to society’s anti-LGBTQIA+ attitudes, can lead to conflicting ideas or feelings about their identity and internal strife.2

Increased risk for mental health conditions
Suicidality
Substance use disorders
Eating disorders

Intersectionality and mental health

Intersectionality is a framework that describes the interconnected nature of the various aspects of a person’s identity. This schema also explores how these intersecting aspects can be associated with disadvantage and discrimination.7

For example, queer and trans individuals may also experience racism, sexism, ableism, or religious discrimination based on other aspects of their identity. This generally contributes to the experience of additional marginalization, discrimination, and prejudice. 

People sitting at the intersection of more than one marginalized identity often face an increased likelihood of multiple hardships. Trans women of color, for example, often experience profound marginalization, oppression, and devastatingly high rates of sexual and physical violence.12,13

LGBTQIA+ youth, discrimination, and mental health

Although more U.S. adolescents are identifying as LGBTQIA+ than ever before, transgender and queer teens still experience a significant amount of social discrimination.

Discrimination at school

A 2019 survey revealed as much as 86% of LGBTQIA+ youth had been assaulted or harassed at school—experiences that can lead to mental health complications.1

Many LGBTQIA+ youth report hearing anti-LGBTQIA+ language, being bullied, and experiencing subtler forms of discrimination while at school, such as a non-inclusive curriculum.

Further, some LGBTQIA+ students report that administrators, teachers, and other adult leaders at school do not intervene when they witness harassment or are told about it directly.8

Students who are targeted because of their gender or sexual orientation tend to have lower grade point averages, are more likely to miss school, and are more likely to opt out of post-secondary education.8

However, intentional and inclusive changes can help make school a safer, more welcoming place for queer and transgender students.

Suicidality

Much like queer and trans adults, young people who identify as LGBTQIA+ are six times more likely to experience severe depression and three times more likely to use illicit substances.9

The high rates of social discrimination may also impact suicide rates in this population, with one study finding high school students identifying as queer more than four times as likely to have attempted suicide than heterosexual students.1

Another study found that LGBTQIA+ youth are 14 times more likely to attempt suicide than their cisgender and heterosexual counterparts.3 Trans and nonbinary students are of particular concern, with about 50% reporting they had seriously considered suicide in the previous year.8

Protective factors for mental health in the LGBTQIA+ community

Social discrimination can have devastating and detrimental effects on mental health. The good news is there are some protective factors against the consequences of transphobia and homophobia, such as:3,10

  • Family and community support
  • Access to affirming and inclusive medical and mental health care
  • Anti-discrimination policies
  • Inclusive and supportive work environments
  • Addressing the social and environmental factors that influence health
  • Experiencing positive reactions to coming out
  • Community building with other LGBTQIA+ people, which can reduce internalized homophobia and transphobia 

A strong support system is crucial for enduring nearly any negative experience in life, including the type of mental and physical stressors brought on by transphobia and homophobia.

On a broader scale, the systemic change needed to create a more welcoming society takes time. But working together in an empowered, supportive community to educate and empower others can help bring it about for the betterment of everyone.

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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. LGBTQI. (n.d.). NAMI. Retrieved June 30, 2023.
  2. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. 
  3. Mental health. (n.d.). CMHA Ontario. Retrieved March 30, 2023.
  4. U.S. Department of Health and Human Services. (2023, February 24). Substance use and suds in LGBTQ* populations. National Institutes of Health. Retrieved June 30, 2023.
  5. Hughto, J. M., Quinn, E. K., Dunbar, M. S., Rose, A. J., Shireman, T. I., & Jasuja, G. K. (2021). Prevalence and co-occurrence of alcohol, nicotine, and other substance use disorder diagnoses among us transgender and cisgender adults. JAMA Network Open, 4(2). 
  6. 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(1). 
  7. Crenshaw, Kimberle. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum, 1989(1): 8.
  8. The effects of homophobia and transphobia on the mental health of LGBTQ+ students. (2022, October 13). Great Lakes Equity Center. Retrieved June 30, 2023.
  9. Stigma and discrimination affects gay and bisexual men's health. (2016, February 29). Centers for Disease Control and Prevention. Retrieved June 30, 2023.
  10. Discrimination impacts the health of LGBT people, Analysis finds. (2019, December 19). Cornell Chronicle. Retrieved June 30, 2023.
  11. Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National Survey on Drug Use and Health. (n.d.). Substance Abuse and Mental Health Services Administration. Retrieved June 30, 2023.
  12. Sexual Assault: The Numbers | Responding to Transgender Victims of Sexual Assault. (n.d.). Office for Victims of Crime (OVC). Retrieved June 30, 2023.
  13. Transgender people are over four times more likely than cisgender people to be victims of violent crime. (2022, December 21). UCLA School of Law Williams Institute. Retrieved June 30, 2023.
  14. Diaz, J. (2021, February 3). New York repeals 'walking while trans' law. NPR. Retrieved June 30, 2023.

FAQs

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