June is LGBTQ+ Pride Month, making it the perfect time to bring awareness to eating disorders within the LGBTQ+ community. Research indicates that eating disorders and disordered eating behaviors disproportionately impact the LGBTQ+ population. Beginning as early as age 12, gay, lesbian, and bisexual individuals may have a higher chance of binge-eating and purging than their heterosexual peers.
Eating Disorder Risk Factors for the LGBTQ+ Population
As explained by the National Eating Disorder Association, these individuals face unique stressors and challenges that increase their risk of developing an eating disorder, including:
Experience of or fear of rejection by loved ones
Internalized negative beliefs about themselves due to sexual orientation, non-normative gender expressions, and/or transgender identity
Experiences of violence and post-traumatic stress disorder (PTSD), which increases vulnerability to disordered eating
Discrimination or being a victim of bullying due to sexual orientation and/or gender identity
Gender dysphoria, the discordance between one’s biological sex and gender identity
Inability to meet body image ideals within some LGBTQ+ cultural contexts
As referenced in the bullet points above, the experience of shame in one’s sexual orientation or gender identity is often a trigger for eating disorder behaviors. In some instances, someone may use an eating disorder or disordered eating to modify their body in an effort to meet a socially-created, gender-specific body type ideal. Additionally, LGBTQ+ young people experience increased instances of homelessness or unsafe home environments, which can lead to the development of an eating disorder as a coping mechanism.
Negative Body Image vs. Gender Dysphoria
When looking at eating disorders among the LGBTQ+ community, it’s important to understand the difference between negative body image and gender dysphoria. Negative body image is being hyper-focused on comparing your size, shape, and/or appearance to unrealistic ideals. These are the beliefs that your body is not attractive or good enough.
Meanwhile, gender dysphoria is discomfort and distress due to the experience of your gender not matching your assigned sex from birth or certain physical characteristics. Eating disorders are particularly prevalent in the transgender community, with a recent study finding that 75 percent of participants identifying as transgender had practiced disordered eating behaviors within the last 12 months — significantly higher than in the rest of the population (around 50 percent for women and 30 percent for men). This high rate of occurrence makes sense: Ultimately, both eating disorders and gender dysphoria center around an unhappiness with one’s body and the subsequent wish to modify it. Eating disorders focus on a desire to lose weight, while gender dysphoria revolves around a wish to change one’s body to align more closely with gender identity. Gender expression is often informed by societal standards of beauty and thus influenced by the “thin ideal” of the culture (thin with curves for women and thin and muscular for men).
It is important to keep both negative body image and gender dysphoria in mind when providing eating disorder support to the LGBTQ+ population and know that when they express their bodies feel "wrong" there are multiple layers to that statement and those need to be explored closely.
Eating Disorder Treatment for LGBTQ+ Patients
Unfortunately, despite the increased risk and unique challenges, LGBTQ+ people often have trouble accessing adequate options for eating disorder treatment. They face obstacles when looking for treatment options that appropriately address the complexity of sexuality and gender identity issues as well as the lack of support from loved ones. Furthermore, there is limited research on eating disorder treatment for this minority group, particularly among LGBTQ+ resource providers who are in the position to identify problems and intervene.
Please know that I am a LGBTQ+ ally and therapist I am ready and willing to address your specific needs as you seek treatment and recovery.
If you or a loved one is struggling with an eating disorder, reach out to Dr. Kelli Malkasian, PsyD, CEDS at Coral Reef Counseling, and schedule a free consultation or telehealth appointment today.