Eating Disorder Treatment Programs for

LGBTQIA People

LGBTQIA stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual, and it encompasses a wide collection of genders and sexual orientations. While not an exhaustive list, the acronym represents minority gender and sexual identities held by nearly 1 million Americans.2

Eating disorders are common in the LGBTQIA community. Research has consistently shown that LGBTQIA adults and adolescents are more likely to experience eating disorders than their cisgender and/or heterosexual peers.1 

While the cause of eating disorders remains elusive, strong evidence suggests that genetic, environmental, and cultural influences are involved. For LGBTQIA individuals, there are additional factors to consider when selecting treatment options.

This article provides a comprehensive overview of eating disorder treatment programs for LGBTQIA people and how to help those who struggle with eating disorders find proper care.

LGBTQIA People

Understanding

LGBTQIA People

with Eating Disorders

The LGBTQIA community faces more social stigma than other groups, leaving them at greater risk for developing eating disorders. 

LGBTQIA individuals with eating disorders may also feel added pressures to hide their gender or sexual orientation alongside their eating disorders due to social stigmas and fear of discovery.

The stress related to the concealment of their true identities may leave LGBTQIA people feeling even more isolated and unsupported. Research has shown that positive, supportive family relationships may protect transgender and gender-diverse (TGD) youth from negative health risks.16

In marginalized groups like the LGBTQIA community, correlated mental health conditions, including depression and anxiety, are more common. Gender and sexual minorities are at higher risk for mental health issues and depression, especially among transgender indivdiuals.3

LGBTQIA People with Eating Disorders: Stats & Trends

Historically, LGBTQIA individuals have not been largely included in eating disorder studies, but that is starting to change. 

A 2018 survey conducted by The Trevor Project and the National Eating Disorders Association (NEDA) found that over 50% of surveyed LGBTQIA youth claimed to have been diagnosed with an eating disorder.4, 5

Eating disorders present themselves across all gender and sexual identities. For example, approximately 42% of men diagnosed with an eating disorder identify as gay or bisexual.15 Similarly, adolescents who identify as lesbian, gay, and bisexual experience a higher past-year prevalence of binge eating and purging behaviors.15

Members of the LGBTQIA community also experience trauma-based shame at higher rates, leaving them more susceptible to mental health disorders.8 However, some LGBTQIA people have seen improvements in disordered eating behaviors after gender reassignment.15 

Social stigmas are common for individuals in the LGBTQIA community, and depression is a significant predictor of eating disorders, especially in gay men and lesbian women.7

LGBTQIA People

Eating Disorder Signs & Symptoms

The following risk factors may place members of the LGBTQIA community at a uniquely higher risk for developing eating disorders:7

  • A lack of social support
  • A low sense of belonging
  • Social stigma and discrimination 
  • Gender role conflicts
  • Bullying 
  • Navigating coming out
  • Rejection due to gender and/or sexual orientation
  • Childhood or adulthood trauma or violence
  • Gender dysphoria or dissatisfaction
  • Dating app use
  • Steroid use and extreme body-building, especially in transitioning and transgender individuals who desire a more masculine appearance9
  • Little to no involvement in the LGBTQIA community

Classic signs and symptoms of eating disorders that are gender-neutral include the following:

  • Regular trips to the restroom 
  • Disguising weight loss with baggy clothes
  • Fainting spells
  • Rigid eating and exercise schedules
  • Skipping meals or avoiding social gatherings where food is served
  • Expressing dissatisfaction with weight, body size, or shape
  • Eating in private 
  • Swelling of face, cheeks, or jaws
  • Feeling cold frequently

Treating

LGBTQIA People

with Eating Disorders

Specialized approaches to treatment are essential for all individuals with eating disorders, but especially for those within the LGBTQIA population.7 

An integrated approach to eating disorder treatment ensures that each patient’s unique needs and challenges are addressed, increasing the likelihood of a full recovery. Patient-centered approaches to care help build the trust and rapport necessary to ensure LGBTQIA patients achieve better overall outcomes.

The following treatment approaches are frequently used to support LGBTQIA patients with eating disorders: 

Individual Therapy

Physicians, psychotherapists, and dietitians routinely provide individualized care for patients with eating disorders. One-on-one therapy usually occurs following, or in addition to, a patient’s participation in a comprehensive program. Other health care providers may also provide episodic care. For example, physical therapy may be necessary for patients with extreme deconditioning after severe weight loss. For LGBTQIA individuals, careful attention should also be paid to social stressors and stigma.

Family-Based Therapy

Family-centric treatment approaches are effective for some patients, especially in younger people. Adolescents who come out earlier may also face social stigma and discrimination. Social stressors related to gender identity can interfere with eating disorder treatment. Establishing a strong family support system is essential to improving treatment outcomes in LGBTQIA youth.

Enhanced Cognitive Behavioral Therapy (CBT-E)

CBT-E (enhanced cognitive behavioral therapy) effectively addresses issues around body dissatisfaction, low self-esteem, perfectionism, low self-worth, and interpersonal relationships. Studies have shown this type of therapy to be nearly twice as effective as interpersonal therapy (IPT).11, 10

Compassion-Focused Therapy has also been identified as a novel approach for transgender and gender non-conforming (TGNC) people.7

Multidisciplinary Care

Multidimensional approaches to the care of patients with eating disorders involve a team of specialized health care professionals who offer comprehensive support. Most multidisciplinary care teams include the following members: 

  • Physician: Manages overall medical care, including monitoring lab values, prescribing medications, and overseeing treatments. 
  • Registered Dietitian: Manages medical nutrition therapy, including correcting fluid and nutritional imbalances.
  • Mental Health Professional: Manages mental health including establishing healthy coping strategies and building strong support systems.
  • Specialized Care Professionals: Manages related disorders, including physical deconditioning and chronic conditions. 

Intensive Treatment

Some LGBTQIA patients may need more intensive treatments, depending on their condition when they seek treatment. Treatments approaches may include:

  • Inpatient Treatment: care provided in a hospital-based setting
  • Residential Treatment: care provided in a non-hospital, facility-based setting
  • Partial Hospitalization (PHP): care delivered in a hospital-based setting during weekdays, with optional overnight stays.
  • Intensive Outpatient Treatment: care delivered in a hospital- or non-hospital-based setting, 3 to 4 times each week.
  • Outpatient Treatment: Ongoing multidisciplinary care delivered in a hospital- or non-hospital-based setting.

Telemedicine 

Telemedicine has grown in popularity over the past decade, and it shows promise for the treatment of many chronic conditions, including eating disorders. Research has shown that internet-based treatment options are effective for patients with eating disorders and may provide gender-affirming care (GAC) options for LGBTQIA people who do not have access to local resources.12

Coping Strategies for

LGBTQIA People

with Eating Disorders

Recovering from disordered eating requires effective coping strategies, strong support systems, and individualized treatment.

LGBTQIA people who also have an eating disorder face additional challenges beyond those encountered by their cisgender and/or heterosexual peers. Social stigmas relating to their gender or sexual orientations may increase stress and anxiety that further drive disordered eating behaviors. 

Perceived social stigma is a known risk factor for depression, especially among individuals of minority gender and sexual orientation, which may require additional mental health care.7

Special consideration should be given to LGBTQIA youth during eating disorder treatment since they experience additional challenges during puberty when significant psychosocial and sexual development occurs. 

Some LGBTQIA patients who have participated in treatment programs for eating disorders have reported feeling disappointed by their providers’ gender incompetence.13 Without proper training, many clinicians are left ill-equipped to help LGBTQIA patients navigate the difficult landscape of social stigmas in addition to their eating disorders.

For this reason, treatment programs for LGBTQIA people should always include elements relating to body acceptance, coping strategies to help patients manage social stigmas related to gender identity, and counseling to address traumatic life experiences that trigger feelings of shame. Program staff should also be well versed in gender competence.

How to Help

LGBTQIA People

with Eating Disorders

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 who has experience working with sexual minority populations.

Eating disorders are serious, and they require immediate medical attention.

Here are a few things you can do to help: 

  • Confirm: Ask how the LGBTQIA person prefers to be addressed and honor their wishes.
  • Ask: Ask how you can help be an ally to support them through their recovery.
  • Listen: Invite them to share personal experiences about their eating disorder.
  • Support: Offer to accompany them to appointments and consultations, even if you only sit in the waiting room.

Withinhealth offers a holistic alternative to traditional eating disorder programs, which does not require an inpatient stay in most cases. Contact Withinhealth to get started today.

Frequently 
asked questions

How can I support an LGBTQIA loved one who is struggling with an eating disorder?

Be supportive and compassionate. Listen to what they are going through without offering advice or insight, and realize even if you have experience with eating disorders, their experience may differ due to their gender or sexual identity. Encourage them to seek help through their physician, a therapist, or right here at Within Health. Ensure whichever provider you go with that they support LGBTQIA patients and their specific needs.

How can you tell if an LGBTQIA individual has an eating disorder?

Eating disorders do not discriminate, and signs of eating disorders among LGBTQIA individuals are similar to those among cisgender populations. Prominent signs of eating disorders include being overly fixated on weight and body image, eating in private, and avoiding activities and gatherings where food is served. Eating disorders can be life-threatening, so finding help as soon as possible is vital.

Where can you find help for a LGBTQIA loved one when you suspect they have an eating disorder?

Withinhealth offers comprehensive, gender competent eating disorder programs to support LGBTQIA individuals. Contact us [insert contact information] to learn more about resources available in your area.

Resources

1. Parker, L.L., Harriger, J.A. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord 8, 51 (2020). 

2. Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender Population Size in the United States: a Meta-Regression of Population-Based Probability Samples. American journal of public health, 107(2), e1–e8. 

3. Su, D., Irwin, J. A., Fisher, C., Ramos, A., Kelley, M., Mendoza, D., & Coleman, J. D. (2016). Mental Health Disparities Within the LGBT Population: A Comparison Between Transgender and Nontransgender Individuals. Transgender health, 1(1), 12–20. 

4. The Trevor Project, National Eating Disorders Association, & Reasons Eating Disorder Center (2018). Eating Disorders Among LGBTQ Youth: A 2018 National Assessment

5. National Eating Disorders Association (2018). Trevor Project Survey Infographic

6. University of Southern California Suzanne Dworak-Peck School of Social Work. Jeremy Goldbach, director of USC LGBT Health Equity Initiative. (March 08, 2018) Are You Sure More Than Half of LGBTQ Youth Have an Eating Disorder? Because Science Says Otherwise

7. Bell, K., Rieger, E., & Hirsch, J. K. (2019). Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model. Frontiers in psychology, 9, 2692. 

8. Scheer, J. R., Harney, P., Esposito, J., & Woulfe, J. M. (2020). Self-Reported Mental and Physical Health Symptoms and Potentially Traumatic Events Among Lesbian, Gay, Bisexual, Transgender, and Queer Individuals: The Role of Shame. Psychology of violence, 10(2), 131–142. 

9. Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020 Nov;33(6):562-567. 

10. Calzo, J. P., Blashill, A. J., Brown, T. A., & Argenal, R. L. (2017). Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations. Current psychiatry reports, 19(8), 49. 

11. de Jong, M., Schoorl, M., & Hoek, H. W. (2018). Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review. Current opinion in psychiatry, 31(6), 436–444. 

12. Stoehr, Jenna & Hamidian Jahromi, Alireza & Hunter, Ezra & Schechter, Loren. (2021). Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action. Transgender Health. 

13. Mary E. Duffy, Kristin E. Henkel & Valerie A. Earnshaw (2016) Transgender Clients’ Experiences of Eating Disorder Treatment, Journal of LGBT Issues in Counseling, 10:3, 136-149, 

14. Fisher J. (2020). Gender competence and mental health promotion. World psychiatry: official journal of the World Psychiatric Association (WPA), 19(1), 34–35. 

15. McClain, Z., & Peebles, R. (2016). Body Image and Eating Disorders Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatric clinics of North America, 63(6), 1079–1090. 

16. Brown, C., Porta, C. M., Eisenberg, M. E., McMorris, B. J., & Sieving, R. E. (2020). Family Relationships and the Health and Well-Being of Transgender and Gender-Diverse Youth: A Critical Review. LGBT health, 7(8), 407–419. 

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