Eating Disorders and the LGBTQ Community

By Margaret Moran, MSW, LCSW

Eating disorders, such as anorexia nervosa and bulimia nervosa, are serious mental health conditions that affect individuals of all backgrounds.

However, research shows that people who are lesbian, gay, bisexual, transgender or queer (LGBTQ) face disproportionately higher rates of these illnesses than their heterosexual and cisgender counterparts.

June is LGBTQ Pride Month, and while it is a time to celebrate the LGBTQ community, it is also a time to recognize the unique challenges and pressures faced by LGBTQ individuals and the increased risk for eating disorders.

At Princeton Center for Eating Disorders at Penn Medicine Princeton Medical Center (PMC) a multidisciplinary team of board certified psychiatrists, other specialized physicians, nurses, psychotherapists and dietitians provide compassionate, equitable, inpatient care for individuals with eating disorders, regardless of sexual orientation or gender identity or expression.

Anorexia and Bulimia

Eating disorders are characterized by severe disturbances in eating behaviors and related thoughts and emotions. Two of the most common eating disorders are anorexia and bulimia.

In general, anorexia is a condition in which people avoid or restrict food or eat very small quantities of only certain foods. Though the individual may be underweight, they continue to see themselves through a distorted lens, often as much bigger than they actually are.

Over time, people with anorexia can become dangerously malnourished and can die of starvation, often experiencing cardiovascular complications as the heart weakens.  In fact, according to the National Institute of Mental Health, anorexia has an extremely high death rate compared to other mental health disorders. Moreover, suicide is the second leading cause of death for people diagnosed with anorexia.

Bulimia is a condition in which people have episodes of overeating and then compensate for the overeating by vomiting, using laxatives or diuretics, excessive exercising or fasting. People with bulimia may be slightly underweight, normal weight or overweight.

Increased Vulnerability

While anorexia and bulimia affect people of all genders and sexual orientations, studies indicate a heightened prevalence within the LGBTQ community, with gay men and transgender individuals at greatest risk.

Consider that according to an article in the “Journal of Eating Disorders,” 14% of gay men reported they suffered from an eating disorder, which is significantly higher than heterosexual men. Additionally, research published in “Current Psychiatry Reports” noted that up to 18% of transgender and gender diverse individuals have eating disorders.

Several factors contribute to this increased vulnerability:

• Poor body image. Poor body image is a contributor to eating disorders in all populations. However, the pressures on LGBTQ people are unique. For example, gay men often encounter cultural ideals that emphasize a lean, muscular physique, while transgender individuals may engage in disordered eating to suppress or accentuate certain physical features that align more closely with their gender identity.

• Struggle with identity. Who am I? Where do I fit in? What do I believe? While these are questions many people ask themselves, they can take on even greater significance for LGBTQ people who may experience stigma, discrimination and social rejection for how they identify.

• Desire for internal control. The desire for internal control is a common factor among most people who experience an eating disorder.  Managing what they eat, how much they eat, and when they eat provides them a (false) sense of control when everything else feels out of control. These feelings can be exacerbated for LGBTQ people, especially those who experience frequent bullying and invalidation.

• Trouble managing uncomfortable emotions. Eating disorders are often used as a way for people to manage uncomfortable emotions and suppress feelings. This is true no matter your sexual preference or gender. However, it becomes even more relevant for LGBTQ people who may not be able to express their true feelings or who seek to “numb out” so they don’t feel the pain of being bullied or rejected.

Signs of an Eating Disorder

The signs and symptoms of an eating disorder are the same for LGTBQ people as they are for heterosexual and cisgender individuals. Some of the most common symptoms include:

• Preoccupation with food, calories and weight.
• Isolation, avoiding social situations that were once pleasurable.
• Extreme concern with body size and shape, engaging in body checking behaviors
• Irritability, mood swings.
• Extreme weight loss, or fluctuations in weight both up and down.
• Difficulty concentrating.
• Frequent trips to the bathroom, particularly after meals.
• Narrowing the variety of acceptable foods, perhaps cutting out entire food groups such as dairy or carbohydrates.
• Developing food rituals (eating foods in a certain order, excessive chewing, rearranging food on plate, etc.).
• Overexercising or a rigid, often excessive, exercise routine.

How to Help

If you think your loved one has an eating disorder, it is important to take action as eating disorders can be life-threatening. 

Gently question your loved one and encourage them to seek professional help. A therapist who is trained in treating eating disorders can work with the individual to identify the underlying issues and can offer more productive ways to cope.

Princeton Center for Eating Disorders at PMC provides a warm, welcoming environment and offers culturally competent care that adapts to the needs of LGBTQ patients. For example, the team makes a point of using chosen names and pronouns, offers gender-affirming medical expertise, and accommodates gender-affirming identity materials, such as binders. 

Patients not only benefit from treatment for the physical, psychosocial and nutritional aspects of their eating disorder, but they also have immediate access to full-service care for other medical needs.

For more information about Princeton Center for Eating Disorders, call (888) 437-1610, option 3, or visit princetonhcs.org/eatingdisorders. 

Margaret Moran, MSW, LCSW, is a licensed clinical social worker and senior eating disorders therapist with the Princeton Center for Eating Disorders at Penn Medicine Princeton Medical Center.