Disordered Eating Among Sexual and Gender Minorities
LGBTQ+ youth are disproportionately affected by eating disorders due to stressors such as discrimination, harassment, and trauma.
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It is no surprise that because adolescents are introduced to strict body image standards, many develop disordered eating habits. Social pressure can encourage unhealthy eating patterns, including anorexia, binge-eating, and bulimia. Eating disorders are serious medical conditions that can lead to early mortality and interfere with growth and development.
Disordered eating habits are most common among sexual and gender minorities. Over one-third of queer youth and over half of transgender and nonbinary youth receive an eating disorder diagnosis at some point in their lifetime, while only 7% of those who do not identify as LGBTQ+ suffer from eating disorders.
Jason M. Nagata and colleagues reviewed possible reasons behind the high rate of eating disorders among LGBTQ+ adolescents. They discussed the prevalence of eating disorders within sexual and gender minority youth, as well as psychological and sociological theories connecting quality of life, mental health, and eating disorders.
The ideal body, and therefore, the manifestations of disordered eating, differ widely across the LGBTQ+ spectrum.
The authors highlight multiple factors that contribute to eating disorders in queer and gender diverse youth. These include external factors, such as discrimination in schools or by the legal system, harassment and sexual assault, as well as internal factors, including self-hatred due to sexual orientation or gender minority. These so-called minority stressors can encourage low self-esteem, anxiety and depression, as well as disordered eating.
Harassment and discrimination directly contribute to distress. LGBTQ+ people are four times more likely to experience physical violence than non-LGBTQ+ people and are more likely to experience both harassment and discrimination. These acts condition queer youth to blame themselves for their mistreatment. They may use eating disorders as a form of self-harm, punishing their bodies through bingeing and food restriction. Disordered eating, specifically binge eating, can also serve as a coping mechanism after experiences of trauma.
The ideal body, and therefore, the manifestations of disordered eating, differ widely across the LGBTQ+ spectrum. Thinness is highly praised among gay men. Gay men are often shown in media portrayals to be eating low-calorie, low-carb diets. Separately, transgender youth often feel pressure to “pass” as cisgender. They may form habits of food restriction or binge eating at the start of puberty as unwanted sex characteristics develop.
Health care providers should screen for possible eating disorders and refer those affected to psychotherapy. The authors recommend that all health care providers consider the multitude of minority stressors that affect youth across the spectrums of gender and sexuality. Gender-affirming care has been shown to improve mental health among transgender and nonbinary youth and should be made available to those who would benefit.
