Eating Disorders in Lesbian, Gay, and Bisexual People

Eating Disorders in Lesbian, Gay, and Bisexual People

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Eating disorders affect people of all ages, genders, ethnicities, and sexual orientations. However, they may disproportionately affect members of certain groups, such as members of a sexual minority. These groups comprise anyone who does not identify as entirely heterosexual, including people who identify as gay, lesbian, or bisexual; those who report attractions to people of the same or multiple genders; and individuals who report engaging in sexual contact with people of the same or multiple genders.

Unfortunately, most of the eating disorder research to date has focused on heterosexual cisgender white women. Less is known about eating disorders among people with diverse sexual orientations. Furthermore, this community faces unique and additional stressors—such as stigma and discrimination—that may affect health.

Another confounding factor is that many studies and articles lump together gender-diverse and sexually-diverse people under the umbrella LGBTQ—lesbian, gay, bisexual, transgender, and queer. However, gender identity and sexual orientation describe different phenomena. Research findings from studies of sexually diverse groups are not necessarily applicable to gender identity diverse groups and vice versa. Transgender people can have any sexual orientation, including heterosexual.

This article will focus on diverse sexual orientation only. For gender diversity in eating disorders, please see Eating Disorders in
Transgender People
.

Even accepting this restriction, gay, lesbian, and bisexual people represent a very diverse group. Research often fails to capture intersecting identities that can increase oppression and stigma—people who are members of multiple marginalized groups may have different experiences as a result of this. Thus, generalizing findings from a group of people who identify as gay or lesbian or bisexual to all people who identify as gay or lesbian or bisexual is not always valid.

Prevalence of Eating Disorders in LGB People

Only a few studies have investigated sexual orientation and eating disorders in adolescents. Some school-based studies have shown that gay boys and boys with same-sex partners had more disordered eating behaviors and more body dissatisfaction than their heterosexual peers. One study found that gay and bisexual secondary school boys and girls were more likely to report purging and diet pill use than their heterosexual peers.

Among Men

Research has consistently demonstrated that gay and bisexual men are disproportionately affected by eating disorders. While only about 3% of the US male population is gay or bisexual, estimates of the percentage of males with eating disorders who are gay or bisexual range from 14 to 42%. A common myth and sometimes stigmatizing factor for men with
eating disorders
is that they are often presumed to be gay. It’s important to note that the majority of males with eating disorders are still heterosexual.

The same holds for sub-clinical eating disorders. Compared to heterosexual men, gay and bisexual men also exhibit more symptoms of disordered eating. One study found that the number of gay and bisexual men with symptoms of disordered eating was ten times higher than among heterosexual men.

Among Women

Among lesbian and bisexual women, findings regarding eating disorders are more mixed. Some studies report increased levels of disordered eating among lesbian and bisexual women, but others show no significant difference from the rates in heterosexual women. One explanation for these conflicting findings may be the lack of efforts to distinguish between the different groups of homosexual women or between queer women of different ethnic groups. A commonly held belief is that lesbian and bisexual girls and women are at reduced risk for eating disorders compared to heterosexual females. Unfortunately, this can lead to a lower likelihood of lesbian and bisexual females with eating disorders getting diagnosed and accessing treatment.

Theories About Mechanisms of Eating Disorders in LGB People

Some of the disparities among prevalence rates between LGB people and their heterosexual peers may be explained by the minority stress model. People of marginalized groups frequently face victimization, discrimination, and adversity arising from their stigmatized identities. They also may receive less social support from family. These stressors can lead to increased risk for a number of health and mental health problems. In terms of eating disorders, people who identify as LGB may attempt to manage stress and distress through behaviors such as dieting or bingeing, which are in turn common symptoms of eating disorders.

Further theories posit that gay culture and the gay community place a heightened focus on physical appearance, putting pressures and demands on gay men that are similar to those felt by heterosexual women. Applying this same lens to lesbian and bisexual women, it has been proposed they may be less prone to eating disorders because they do not share the standards of feminine beauty and pressures placed on heterosexual women by Western culture.

While provocative, these theories about the role of physical appearance have not been tested and there is a profound risk in reducing eating disorders in a large group of diverse people to a single mechanism. There is much more to eating disorders than body image. Eating disorders are caused by a complex interplay of genetic and environmental factors.

Treatment of LGB People With Eating Disorders

There are no treatments specifically for LGB people with eating disorders. Treatments developed for heterosexual patients may be effective when applied with cultural sensitivity. It is important for providers to attend to issues about sexual identity. Therapists can help patients to address internalized homophobia and coming out and to work on self-acceptance and increasing self-esteem. Because LGB people may lack social support, increasing it can also be an important focus of treatment.

Unfortunately, LGB people can face increased barriers to treatment. Almost all of the materials about eating disorders are written for cisgender heterosexual women so diverse people may not feel welcome at eating disorder treatment facilities. LGB people may face a lack of culturally competent providers who have both eating disorder expertise and sensitivity to the complexity of their sexual identity. Or they may feel uncomfortable talking about their experiences in treatment environments where the majority of people are heterosexual. They may need extra support and connection with other LGB people. When that cannot be found within their treatment environment, they may find it in support communities online.

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Article Sources

  • Arcelus, Jon, Fernando Fernandez-Aranda, and Walter Pierre Bouman, Eating Disorders and Disordered Eating in the LGBTQ Population. Clinical Handbook of Complex and Atypical Eating Disorders. 327-344. Oxford University Press. New York.

  • Bell, Kathryn, Elizabeth Rieger, and Jameson K. Hirsch. 2018. “Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-Conforming Adults: Comparative Levels and a Proposed Mediational Model.” Frontiers in Psychology 9: 2692. https://doi.org/10.3389/fpsyg.2018.02692.

  • Calzo, Jerel P., Aaron J. Blashill, Tiffany A. Brown, and Russell L. Argenal. 2017. “Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations.” Current Psychiatry Reports 19 (8): 49. https://doi.org/10.1007/s11920-017-0801-y.

  • Feldman, Matthew B., and Ilan H. Meyer. 2007. “Eating Disorders in Diverse Lesbian, Gay, and Bisexual Populations.” The International Journal of Eating Disorders 40 (3): 218–26. https://doi.org/10.1002/eat.20360.