Eating Disorders in the LGBTQ Community

Eating disorders are complex, potentially deadly illnesses that affect people of every race, ethnicity, gender identity, sexual orientation, and socioeconomic background. Despite research showing the prevalence of eating disorders across populations1, many people continue to see these conditions as exclusive to young, white, heterosexual, and cisgender females.  

Misconceptions about eating disorders, who they affect, and how the symptoms manifest can lead to dangerous oversights in the diagnosis and treatment of these illnesses among minority and gender-diverse populations.

Eating Disorders Among LGBTQ Individuals

Multiple studies have shown that LGBTQ individuals, particularly teens and young adults, are at greater risk of developing an eating disorder than their cisgender, heterosexual peers3. They also face significant barriers in accessing inclusive and gender-affirming care2 when they are diagnosed. 

In 2021, The Trevor Project, (a prominent LGBTQ suicide prevention organization) surveyed nearly 35,000 LGBTQ young people as part of their National Survey on LGBTQ Mental Health.

Some of they key findings of the survey include: 

• 9% of LGBTQ people ages 13-24 said they had been diagnosed with an eating disorder; a further 29% said they haven’t been formally diagnosed with an eating disorder, but suspect they have one
• Transgender boys and men and nonbinary people assigned female at birth reported the highest rates of eating disorder diagnoses and were more likely to say they suspect they have an eating disorder than other gender identities
• Among racial and ethnic identities, native/indigenous and multiracial LGBTQ youths reported more eating disorder diagnoses than any other races or ethnicities. 

Eating Disorders and Suicide Risk Among LGBT Youth

The survey from the Trevor Project also revealed a correlation between eating disorders and suicide attempts among LGBTQ youth: 

• LGBTQ teens and young adults with an eating disorder diagnosis are nearly four times more likely to attempt suicide than peers who have never been diagnosed or suspected they have an eating disorder
• Transgender and nonbinary teens and young adults reported higher rates of attempted suicide than cisgender LGBQ youths; however, the correlation between eating disorders and suicide attempts was strong for both groups

Eating Disorders Among Transgender People

A large-scale 2015 study of eating disorders among college students revealed that transgender students were more likely than their cisgender gay and heterosexual peers to report disordered eating habits and compensatory behaviors6. 

In an additional study, transgender people reported greater instances of restrictive dieting, use of diet pills, use of non-prescription steroids, excessive fasting, binge eating, purging, and other disordered eating habits than non-gender-diverse people3. They are also more likely to experience mental health problems like depression and anxiety, which further escalates their risk of disordered eating. 

There are multiple potential risk factors for eating disorders among transgender and gender-diverse people. 

These individuals face a host of chronic stressors that are unique to their gender identities and experiences of the world3:

• Body image issues and body dissatisfaction, especially before and during puberty
• Lack of timely treatment for gender dysphoria
• Gender-based discrimination and harassment
• Being denied gender-affirming medical care
• Lack of affirmation of gender identity
• Gender-based stigma and victimization 

Transgender individuals with eating disorders are more likely to self-harm, experience suicidal ideations, and attempt suicide than both transgender people without eating disorders and cisgender people with eating disorders7.

Eating Disorders Among Gay and Bisexual Men

In a study from 2007, gay and bisexual men were found to have significantly higher rates of eating disorders than heterosexual men; participating in recreational clubs in the gay community was correlated with a higher likelihood of disordered eating5, though current research cannot offer an explanation for this finding. In fact, other studies have found that participation in the gay community may actually lower the risk of eating disorders among gay men by providing a sense of belonging and affirmation. 

The 2007 study was the first to assess DSM diagnostic categories and found that gay and bisexual men were found to have a significantly higher lifetime prevalence of full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder. Rates of binge eating, purging, and laxative abuse were much higher among people who identified as gay, lesbian, bisexual, or mostly heterosexual than people who identified as heterosexual.

One explanation for the increased rates of eating disorders in gay and bisexual men is the sociocultural perspective, which proposes that people’s behaviors are influenced by the norms and values of their social and cultural environments. Gay and bisexual men are influenced by a unique set of beauty standards and physical ideals and may feel pressured to conform to a certain body type. 

Additionally, gay and bisexual men (and all other sexual and gender minority groups) experience unique stressors that increase their risk for physical and mental health disorders. LGBTQ people experience external stressors like discrimination, harassment, social stigma, violence, and victimization as well as internal stressors like shame, guilt, fear, and concealment. They face an increased risk of developing substance abuse issues and mental health disorders like depression and anxiety, each of which can contribute to their risk of body image issues and eating disorders. 

Gender-Affirmative Treatment for Eating Disorders at Toledo Center

Toledo Center is a gender-inclusive eating disorder treatment center located in Sylvania, Ohio. We are committed to recognizing, affirming, and honoring the identities and genders of all people in our treatment programs. We offer compassionate treatment and therapy for anorexia, bulimia, binge eating disorder, and purging disorder, and we proudly serve individuals of every gender identity, sexual orientation, and background.

Contact Toledo Center today at 844-901-0857 to learn how our compassionate staff can help you or your loved one begin the journey toward lasting recovery.

Sources:

1. Halbeisen, Georg, et al. “A Plea for Diversity in Eating Disorders Research.” Frontiers in Psychiatry, vol. 13, 18 Feb. 2022, https://doi.org/10.3389/fpsyt.2022.820043.
2. Ferrucci, Katarina A., et al. “Provider Perceptions of Barriers and Facilitators to Care in Eating Disorder Treatment for Transgender and Gender Diverse Patients: A Qualitative Study.” Journal of Eating Disorders, vol. 11, no. 1, 8 Mar. 2023, https://doi.org/10.1186/s40337-023-00760-9.
3. Parker, Lacie L., and Jennifer A. Harriger. “Eating Disorders and Disordered Eating Behaviors in the LGBT Population: A Review of the Literature.” Journal of Eating Disorders, vol. 8, no. 1, 16 Oct. 2020, https://doi.org/10.1186/s40337-020-00327-y.
4. Riddle, Megan C., and Joshua D. Safer. “Medical Considerations in the Care of Transgender and Gender Diverse Patients with Eating Disorders.” Journal of Eating Disorders, vol. 10, no. 1, 21 Nov. 2022, https://doi.org/10.1186/s40337-022-00699-3.
5. Feldman, Matthew B., and Ilan H. Meyer. “Eating Disorders in Diverse Lesbian, Gay, and Bisexual Populations.” International Journal of Eating Disorders, vol. 40, no. 3, 2007, pp. 218–226, www.ncbi.nlm.nih.gov/pmc/articles/PMC2080655/, https://doi.org/10.1002/eat.20360.
6. Diemer, Elizabeth W., et al. “Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students.” Journal of Adolescent Health, vol. 57, no. 2, Aug. 2015, pp. 144–149, www.ncbi.nlm.nih.gov/pmc/articles/PMC4545276/, https://doi.org/10.1016/j.jadohealth.2015.03.003.
7. Duffy, Mary E., et al. “Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals with Eating Disorders: A National Study.” Journal of Adolescent Health, vol. 64, no. 4, Apr. 2019, pp. 461–466, https://doi.org/10.1016/j.jadohealth.2018.07.016.