LGBTQ individuals experience higher rates of eating disorders compared to their heterosexual and cisgender peers as well as more severe eating disorder symptoms upon entering treatment. Additionally, research indicates that particular populations of the LGBTQ community, such as those who identify as transgender or nonbinary, may be at greater risk for developing an eating disorder. While there is still a lack of research on the relationship between sexuality, gender identity, body image, and eating disorders, we know that LGBTQ identified folks experience unique stressors that can contribute to the development of an eating disorder.
Risk Factors
Potential risk factors that may play a role in the development of an eating disorder among LGBTQ individuals can include:
- Experiences of rejection or fear of rejection by friends, family, and co-workers.
- Internalized negative messages/beliefs about oneself due to sexual orientation and/or gender identity.
- Experiences of violence and post-traumatic stress disorder (PTSD), which research shows sharply increases vulnerability to an eating disorder.
- Discrimination and stigma due to one’s sexual orientation and/or gender identity.
- Being a victim of bullying due to one’s sexual orientation and/or gender identity.
- Inability to meet body image ideals within some LGBTQ cultural contexts.
LGBTQ youth also experience increased risks of homelessness and unsafe home and school environments:
- LGBTQ youth reported a 120% higher risk of experiencing homelessness compared to their heterosexual and cisgender peers. Additionally, LGBTQ youth who identified as black or multiracial had some of the highest rates of homelessness.
- LGBTQ youth are also more likely to experience sexual, psychological, and physical abuse than straight/cisgender youth.
- Furthermore, 36% of LGBTQ youth reported that they have been physically threatened or harmed due to either their sexual orientation or gender identity.
Barriers to Support and Treatment
LGBTQ people, in addition to experiencing unique contributing factors that place them at a higher risk for developing an eating disorder, may also face challenges in accessing the treatment and support needed to address an eating disorder. Common barriers to treatment may include: A shortage of culturally competent and affirming treatment, including insufficient eating disorders education among LGBTQ resource providers who are in a position to detect and intervene as well as a lack of eating disorder specialists who are trained to work with LGBTQ individuals. As a result many LGBTQ people delay necessary treatment. For example, one study found that participants who had to educate health care providers about transgender people were 4 times more likely to delay necessary health care. Additionally 60% of LGBTQ youth who wanted mental health care were not able to get it.
- LGBTQ people are more likely to experience discrimination, harassment and denial of services by health and mental health care providers compared to the general population. One survey found that more than 1 in 5 LGBTQ adults avoided medical care due to discrimination by health care providers. Additionally, the same survey found that 1 in 3 LGBTQ people experienced mistreatment by a mental health care provider within the last year.
- Structural inequities such as higher levels of unemployment, poverty, food insecurity and a lack of access to health insurance are additional barriers to treatment. For example, LGBTQ people are more likely to delay medical and mental health care due to the cost of treatment compared to heterosexual/cisgender people with 18.4% of LGBTQ people delaying mental health care compared to 4% of straight/cisgender people and 15.3% of LGBTQ people delaying mental health care compared to 8.8% of straight/cisgender people.
The emergence of LGBTQ youth drop-in centers, gay-straight alliances, LGBTQ community centers, and LGBTQ healthcare resources have created more safe spaces to access support and mental health care overall. However, many LGBTQ people still remain isolated in communities that do not offer such services/programs as most LGBTQ centers and healthcare resources are located in urban areas and coastal states.
In addition to a lack of LGBTQ centers and resources in many parts of the country, there has also been an increase in discriminatory laws which prohibit LGBTQ individuals from accessing affirming health care. For example, 19 states have passed discriminatory laws and policies that prohibit gender affirming care and 5 states have bans that make it a felony to provide gender affirming medical care to transgender youth. Furthermore, there are many states that do not have laws to protect LGBTQ people’s right to access necessary medical care with 44 % of the LGBTQ population living in states that do not have LGBT-inclusive insurance protections. This increase in discriminatory laws may further discourage LGBTQ folks from seeking treatment for an eating disorder given the research on how LGBTQ people often avoid or delay treatment due to experiences of discrimination or anticipation of being discriminated against.
Protective Factors
There are several factors that may protect LGBTQ folks from engaging in disordered eating behaviors and/or developing eating disorders. Research has shown that some of these protective factors can include:
- Perceived support from family, school connectedness, and friend caring were linked to lower rates of disordered eating compared to those who did not experience these social supports.
- Self-compassion was shown to be a protective factor for LGBTQ individuals and was associated with lower rates of disordered eating.
Research of LGBTQ People and Eating Disorders
Research remains limited on eating disorders among LGBTQ populations.
Existing research shows that:
- Gay men are seven times more likely to report binge-eating and twelve times more likely to report purging than heterosexual men.
- Gay and bisexual boys are significantly more likely to fast, vomit, or take laxatives or diet pills to control their weight.
- LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts.
- Nearly nine in ten (87%) LGBTQ youth reported being dissatisfied with their body.
- Rates of body dissatisfaction were higher among transgender and nonbinary youth (90%) compared to cisgender youth (80%).
- LGBTQ youth who have ever been diagnosed with an eating disorder had nearly four times greater odds of attempting suicide in the past year compared to those who have never suspected nor had an eating disorder diagnosis.
- Members of the LGBTQ community are at greater risk for food insecurity, eating disorders, and depression, particularly those who identify as trans males.
- Transgender college students are over four times more likely than their cisgender counterparts to report an eating disorder diagnosis.
- 32% of transgender people report using their eating disorder to modify their body without hormones.
- 56% of transgender people with eating disorders believe their disorder is not related to their physical body.
- Gender dysphoria and body dissatisfaction in transgender people is often cited as a key link to eating disorders.
- Non-binary people may restrict their eating to appear thin, consistent with the common stereotype of androgynous people in popular culture.
