How to Support LGBTQIA+ Individuals with Eating Disorders

June is Pride Month, a time to celebrate the LGBTQIA+ community and sexual and gender diversity. Members of the community and allies unite in pride and solidarity to recognize, honor, and uplift the voices of lesbian, gay, bisexual, transgender, and queer and/or questioning people.

As we honor the LGBTQIA+ community this month and beyond, we must also commit to better understanding and addressing the issues it faces. One such issue is eating disorders, which affect LGBTQIA+ people at disproportionately high rates.

In this article, we explore eating disorders in the LGBTQIA+ community and offer ways to support affected community members during Pride and throughout the year.

Eating disorders in the LGBTQIA+ community

Eating disorders aren’t unique to straight, cisgender women. They cut across all social categories and intersections, including sexual orientation and gender identity. While the majority of the field’s research has focused historically on straight females, the studies involving LGBTQIA+ people show high prevalence rates of eating disorders.

In fact, research suggests that some LGBTQIA+ community members experience eating disorders at even higher rates than their straight and cisgender counterparts.

• In one study, 54% of LGBTQIA+ adolescents and young adults surveyed indicated that they had a diagnosed eating disorder, and an additional 21% suspected that they had an eating disorder (NEDA).
• Men who identify as gay are thought to represent 5 percent of the total male population, but among males who have eating disorders, 42 percent identify as gay (NEDA).
• People who identify as gay, lesbian, bisexual, or “mostly heterosexual” experience elevated rates of binge eating and purging as compared to their heterosexual peers (Bryn et al., 2009).

Like eating disorders in other populations, eating disorders in the LGBTQIA+ community are complex and multifactorial. Sexual or gender identity alone does not predict who will develop one, as other biological, psychological, and social factors also play a part. Experiences related to sexual orientation and gender identity can, however, contribute to the development or maintenance of an eating disorder.

Factors that may increase the likelihood of an eating disorder in a susceptible LGBTQIA+ person include:

• Discrimination, harassment, and bullying related to sexual orientation or gender identity
• Anxiety and fear of rejection about coming out
• Internalized homophobia, transphobia, or misogyny
• Gender dysphoria experienced by trans and/or non-binary individuals
• Appearance ideals within certain segments of the LGBTQIA+ community (especially gay men)

How to support LGBTQIA+ individuals with eating disorders

Support is key to recovery for people of all gender and sexual identities. And true support means caring for the whole person instead of just their illness. When supporting LGBTQIA+ people with eating disorders, it is vital to affirm their gender and sexual identities and to recognize how these identities intersect with the experience of illness and recovery.

Here are some strategies to provide support that is safe, inclusive, and affirming for LGBTQIA+ community members with eating disorders.

1. Center LGBTQIA+ voices and experiences.

Start by simply listening to LGBTQIA+ people about their relationship with food and their bodies. Remember that each person is the expert of their experience, and any support offered should respect their individuality and guidance on what is and is not helpful.  

Some practical tips for actively listening and learning include:

• Create a safe space for people to share what they need, making it known that you will listen with confidentiality and without judgment.
• Ask how you can help using questions like: What can I do? Would you like to research LGBTQIA+-friendly treatment options together? Would it be helpful to share a meal? What isn’t helpful?
• Read and listen to the experiences of people in the LGBTQIA+ community, understanding that there is no singular story. This blog and this podcast will get you started.

2. Affirm each person’s identity through inclusive language.

Adopt language that affirms all gender and sexual identities.

• Introduce yourself with your name and pronouns and ask others for theirs.
• Practice using gender-neutral terms (e.g., “everyone”) in place of gendered ones (“men and women”).
• Create intake forms that don’t assume sexual or gender identity.

3. Acknowledge the intersection of eating disorders and LGBTQIA+ identities. 

Eating disorders can affect the LGBTQIA+ community in unique ways. Recognize that special factors may play a role in the development and maintenance of these illnesses in this population, including:

• Eating disorders being overlooked or dismissed across the LGBTQIA+ community because they do not fit the stereotype
• Discordance between body and gender identity among trans and/or non-binary people that can trigger disordered behaviors as a means to improve body dissatisfaction or distress
• An elevated drive for muscularity among gay men that can introduce or exacerbate eating disorder symptoms

Learn more about eating disorders among lesbian, gay, and bisexual individuals here, and about eating disorders in transgender individuals here.

4. Appreciate that recovery is not one size fits all.

Eating disorder recovery looks different for everyone, and several mainstream recovery messages may be particularly out of touch with the experiences and needs of LGBTQIA+ people.

When providing messages of support, be wary of:

• Messages championing total body positivity (e.g., “Your body is perfect the way it is!” “Love the skin you’re in!”), which can be invalidating for those experiencing gender dysphoria
• Messages celebrating the return of menses, which can be dysphoric for trans and non-binary individuals
• Heteronormative and patriarchal messages meant as motivation in recovery (e.g., “Guys like women with curves.”)

5. Support efforts toward greater inclusion and diversity.

LGBTQIA+ individuals face unique barriers to eating disorder treatment, and ensuring that the community has access to care is ongoing work.

Support efforts toward greater inclusion and diversity in the field, including:

• Striving to make all eating disorder programs safe and affirming spaces
• Continuing education on the unique needs and experiences of LGBTQIA+ people with eating disorders
• Ensuring LGBTQIA+ people are included in research that informs social and healthcare policies

Much like recovery itself, supporting LGBTQIA+ people with eating disorders is an active process that requires compassion and sensitivity. To be helpful is to be inclusive, non-judgmental, and culturally competent. Care must be tailored to the needs of each person, reflecting an understanding of and respect for each person’s identity and unique life experiences.

Attend our complimentary event, “Embodied Dignity: Considerations for Clinical Practice at the Intersections of Eating Disorders and the Dazzling Spectra of Sexuality & Gender Identity,” presented by Chase Bannister, MDIV, MSW, LCSW, CEDS, on June 9. Register today to learn more on this topic and earn continuing education credits.