This article discusses how eating disorders affect lesbian, gay, and bisexual (LGB) people, including the prevalence of these conditions and some of the risk factors involved. It also explores how stigma and other disparities may contribute to the onset of eating disorders in members of these groups.
Considerations About Eating Disorders Among LGB People
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 other sexual orientations. 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. Even accepting this restriction, gay, lesbian, and bisexual people represent a very diverse group. Research often fails to capture intersecting identities that can influence experiences of oppression and stigma—people who are members of multiple marginalized groups may further have different experiences.
Prevalence of Eating Disorders in LGB People
Only a few studies have investigated sexual orientation and eating disorders in adolescents. Some previous studies have shown that adolescent gay boys and boys with same-sex partners had more disordered eating behaviors and more body dissatisfaction than their heterosexual peers. Another 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
While the majority of men with eating disorders are heterosexual, research has consistently demonstrated that gay and bisexual men are disproportionately affected by eating disorders. 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 10 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 possible explanation for these conflicting findings may be the lack of effort to distinguish between the different groups of homosexual women or between queer women of different ethnic groups.
Impact of Minority Stress and Appearance Ideals
While eating disorders have complex causes, some theories have emerged to explain why LGB people might be more likely to develop eating disorders. Two of these theories are focused on the ways that minority stress or appearance ideals increase the risk of eating pathology.
Minority Stress
Some of the disparities among prevalence rates between LGB people and their heterosexual peers may be explained by the minority stress model. In terms of eating disorders, people who identify as lesbian, gay, or bisexual may attempt to manage stress and distress through behaviors such as dieting or bingeing, which are in turn common symptoms of eating disorders. One review of past research found that minority stress including stigma, discrimination, internalized homophobia, and having to conceal sexual or gender identity was associated with more disordered eating behaviors.
Appearance Ideals
Other theories propose that appearance ideals about how gay, lesbian, and bisexual people should look can also play a role in the increased risk for eating disorders. These appearance ideals stem from a variety of sources including traditional media, LGBTQ-specific media, dating apps, family members, and social media. Intersectional identity pressures can add further complications. Appearance ideals are also affected by expectations based on gender, sexual orientation, race, and other aspects of identity. More research is needed to explore the role that expectations surrounding physical appearance affect eating disorders among LGB people. It is also important to consider the risk of reducing eating disorders in a large group of diverse people to a single mechanism.
Treatment for Eating Disorders in LGB People
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 LGB people who are affected by eating disorders address internalized homophobia and coming out. They can also help clients work on self-acceptance and increasing self-esteem. Unfortunately, LGB people can face increased barriers to treatment. Among these possible barriers:
Lack of identity-specific interventions: Almost all of the materials about eating disorders are written for cisgender heterosexual women. As a result, people who do not fit this mold may not feel welcome at eating disorder treatment facilities.Poor access to culturally-competent treatment providers: 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.Lack of social support: 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.
A Word From Verywell
While the exact reasons why LGB people have a higher prevalence of eating disorders are not entirely clear, it is essential to seek professional help if you are struggling with disordered eating or an eating disorder. Consider talking to your healthcare provider or a mental health professional about treatment options that can help. If you are struggling to access or afford eating disorder treatment, there are a number of options available. This includes treatments that may be available if you don’t have insurance coverage, including community mental health centers, support groups, and online tools. For more mental health resources, see our National Helpline Database.
