Eating Disorders in the Lesbian, Gay, and Bisexual Community

Eating disorders are disproportionately common in segments of the LGBTQ community. Disproving the myth that these illnesses impact only straight, cisgender people, research and personal accounts show that all sexual and gender identities are affected—and sexual and gender minorities perhaps even more so than non-LGBTQ people.

The LGBTQ acronym encompasses several distinct sexual and gender identities. It is an umbrella term that represents a group as diverse and varied as non-LGBTQ people, though often treated as a singular group. While we cannot generalize eating disorder experiences within the LGBTQ community—or outside of it—here we explore eating disorders in one segment: those who identify as lesbian, gay, and bisexual (LGB). These terms refer to sexual orientation, while “transgender” refers to gender identity. For more on eating disorders in those who identify as transgender, please read Eating Disorders in the Transgender Community.

Sexual Minorities with Eating Disorders

As with other marginalized groups, LGB people are underrepresented in eating disorder research and the paradigms from which it is drawn. The few published studies offer the following statistics about eating disorders in these populations:

• Gay and bisexual men have a higher prevalence of eating disorder symptoms than heterosexual males do. Compared to 1% of heterosexual males, 6% of gay or bisexual males meet the criteria for an eating disorder (Feldman & Meyer, 2007).
• Gay men account for 42% of men with diagnosed eating disorders in America, even though they make up less than 5% of the total population (NEDA).
• As young as age 12, gay, lesbian, and bisexual teens are more vulnerable to binge-eating and purging than their heterosexual peers are. Gay male teenagers are 7 times more likely to report bingeing and 12 times more likely to report purging than heterosexual males are (Austin et al., 2009).
• Lesbian and bisexual women experience higher rates of binge eating than their heterosexual peers do (Mason & Lewis, 2015).

There is still tremendous need for representation and inclusivity of LGB people in eating disorder research, especially that which addresses how experiences may differ across lesbian, gay, and bisexual populations. As the research above suggests, those who identify as bisexual are often grouped together in research with those who identify as gay or lesbian. As a result, we know little about the unique experiences and needs of these distinct populations. We cannot assume that bisexual men and women experience food and their bodies as other segments of the LGBTQ community do, even though they experience similar social marginalization.

By the same token, we cannot apply our dominant understanding of eating disorders indiscriminately to those who identify as LGB, as this understanding largely reflects the experiences of heterosexual girls and women. To do so would be to overlook and misrepresent the unique factors contributing to eating disorders in LGB groups, as well as diverse presentations of illness and recovery. Assuming that lesbians and bisexual females are less susceptible to cultural appearance standards and thus eating disorders, for example, may mask eating disorders rooted in other contextual factors.

Risk Factors

In addition to general risk factors, LGB-identified people experience social stressors that can contribute to the development of mental health problems, including and in addition to eating disorders. The following factors may put LGB people at particularly high risk of developing an eating disorder:

• Discrimination based on sexual orientation
• Bullying and verbal or physical harassment
• Experiences of PTSD
• Experiencing or fearing rejection from family, friends, and peers
• Heightened anxiety and depression
• Substance use and misuse
• Internalized social stigma
• Low self-esteem
• Negative self-talk
• Isolation
• Appearance-related social norms, especially for gay men

Barriers to Treatment

Compared to their straight counterparts, LGB people experience greater barriers to health care, including eating disorder services. Some barriers to treatment experienced by LGB people include:

• Lack of culturally competent eating disorder treatment (or lack of eating disorder knowledge among LGB providers)
• Lack of support from family and friends
• Discrimination and mistreatment from providers
• Feeling unwelcome, judged, or uncomfortable during medical appointments
• Fear that treatment will rush the coming out process

Those marginalized by sexual identity as well as other identities deserve culturally and clinically competent care for their eating disorders. If you are a member of the LGBTQ community or another marginalized population struggling with food or your body, please know help is available. Reach out to The Emily Program at 1-888-364-5977 to connect with a personalized treatment team today.