Research Indicates Elevated Eating Disorder Risk Among LGBTQIA+ Individuals, Treatment Adaptations Required

Research consistently indicates that individuals within the LGBTQIA+ community face a significantly higher risk of developing eating disorders compared to the non-LGBTQIA+ population. Eating disorders are serious mental health conditions that impact a person's eating behaviors and overall well-being. In 2023, approximately 1.1 million Australians, representing 4.5% of the population, were living with an eating disorder. The increased vulnerability for LGBTQIA+ individuals is attributed to factors such as minority stress and gender dysphoria, highlighting the need for adapted treatment approaches.

Understanding Eating Disorders

Eating disorders are mental health conditions that disrupt a person's eating patterns, leading to detrimental effects on both physical and mental health. While anorexia nervosa and bulimia nervosa are widely recognized, binge eating disorder and avoidant/restrictive food intake disorder are also prevalent. Binge eating disorder involves consuming large quantities of food rapidly, often with a feeling of loss of control. Avoidant/restrictive food intake disorder is characterized by restricting eating due to factors such as sensory sensitivity, lack of appetite, or fear of illness or choking.

These conditions can cause significant damage to organs, bones, fertility, and brain function. Individuals diagnosed with an eating disorder face up to five times higher likelihood of early mortality compared to those without one.

Elevated Risk in LGBTQIA+ Communities

Studies consistently show higher rates of eating disorders among LGBTQIA+ individuals. A 2018 survey of LGBTQ youth in the United States reported that 54% had received an eating disorder diagnosis, with an additional 21% suspecting they had an eating disorder without a formal diagnosis.

Specific risk variations observed within the LGBTQIA+ community include:

• Lesbian, gay, and bisexual individuals are reported to be over twice as likely to have an eating disorder as heterosexual individuals.
• Intersex individuals are nearly four times as likely as endosex (non-intersex) individuals.
• Transgender individuals are nearly 11 times more likely than cisgender people.

While data for asexual individuals is limited, reports of poorer body image within this group suggest a potential for higher eating disorder rates.

Contributing Factors

The elevated risk of eating disorders in LGBTQIA+ individuals is not attributed to biological factors. Instead, two primary non-biological risk factors have been identified: minority stress and gender dysphoria.

Minority stress refers to the negative health impacts resulting from discrimination and stigma experienced by LGBTQIA+ people. This suggests that societal treatment, rather than identity itself, contributes to the increased risk. Discrimination can lead to feelings of shame regarding identity and body, with some individuals developing disordered eating behaviors as a coping mechanism. For intersex individuals, medically unnecessary childhood surgeries intended to "normalize" their bodies can cause trauma and shame, which may contribute to an increased risk of eating disorders.

Many transgender individuals experience gender dysphoria, characterized by distress, discomfort, or a disconnect between their gender identity and their physical body or how they are perceived by others. For some transgender individuals, eating disorders may be an attempt to alleviate gender dysphoria. In transgender adolescents, eating disorders sometimes develop as a strategy to halt puberty, particularly when access to puberty-blocking medications is limited. This can involve restricting food intake to reduce the appearance of breast tissue or to stop menstruation.

Treatment Considerations and Adaptations

Standard eating disorder treatment typically involves a multidisciplinary team, including a doctor, mental health professional, and dietitian. Care can be provided in community settings or hospitals. However, existing treatments were not originally designed with LGBTQIA+ individuals in mind. Consequently, LGBTQIA+ individuals have reported more negative treatment experiences than the general population.

For example, mirror exposure exercises, a common therapy used to reduce body image distress, can reportedly exacerbate gender dysphoria for some transgender individuals.

To be effective, treatment approaches require adaptation to meet the specific needs of LGBTQIA+ individuals. This may include:

• Consistent use of correct names and pronouns.
• Implementation of inclusive language and gender options on administrative documents.
• Clear communication that LGBTQIA+ individuals are welcome within the service.
• Integration of gender-affirming medical care into eating disorder treatment plans.
• Addressing minority stress through a trauma-informed lens, which involves validating experiences of discrimination and stigma, and collaborating to develop healthier coping strategies and stronger support systems.