Hidden Risks for the LGBTQ+ Community, and How You Can Help

 


Every June, Pride month provides an opportunity to share awareness, knowledge and recognition of important issues facing the LGBTQ+ community. It’s a time to celebrate progress while recommitting to challenges that lie ahead. One such challenge among the LGBTQ+ community too often stays hidden: eating disorders.

While eating disorders may happen to anyone, current research suggests that those in the LGBTQ+ community may be at higher risk,1  beginning as early as age twelve.2  In a study of over 35,000 students, gay males were 28 percent more likely to report poor body image, 25 percent more likey to engage in binge eating, and 9 percent more likely to diet frequently compared to heterosexual males.3  What’s important to highlight is how outside influences can act as a trigger for these unhealthy and dangerous behaviors in marginalized populations. For example, daily discrimination among lesbians is associated with increased binge eating.

Let’s take a closer look at stressors that may be unique to the LGBTQ+ community, including those listed by NEDA (The National Eating Disorders Association)and others identified by our patients and therapists.


Unique Stressors Faced by LGBT+ Individuals

  • Fear of rejection after coming out to one’s friends, family, classmates, co-workers and the public
  • Bullying, violence or threats at school, work or online, in some cases resulting in Post Traumatic Stress Disorder (PTSD)
  • Discrimination based on gender identity or sexual orientation
  • Hardship or stress related to identification with a gender that is different than the one assigned at birth
  • Internalized stigma where one begins to believe, internalize and/or act upon negative messages about oneself
  • Homelessness or unsafe homes occur among the LGBTQ+ population, with 42 percent of homeless youth identifying as such6
  • Unrealistic Body ideals within LGBTQ+ peers/community
  • Double minority status wherein one person experiences oppression as a member of more than one minority group (i.e. related to orientation, gender, religion, race or otherwise).


The Transgender Community

Specifically among transgender youth, a 2017 study reported that as many as one in four youths report engaging in at least one disordered eating behavior, with 35 to 45 percent engaging in binge eating or fasting. Experiences of discrimination, harassment, and violence – or enacted stigma – were often linked to greater levels of eating disorder behaviors among trans youth.7

This same study also indicated that there are some protective factors that help buffer enacted stigma from influencing eating habits in trans youth. Social support from family, friends and peers was associated with a lower percentage of trans youth engaging in binge eating. In other words, when family and school connectedness are present in the youth’s life the likelihood of binge eating decreases. In particular, the presence of family support drove the lowest probability of disordered eating.


Showing Support to the LGBTQ+ Community – 8 Ways to Help

Everyone can do their part to help lower risk factors associated with eating disorders in the LGBTQ+ community. The common thread is championing less violence and discrimination and more support and acceptance. Here are eight way you can help:

  1. Know the signs and symptoms of disordered eating and be able to recognize them in a friend, family or peer. Watch this video for an example of how everyday conversations can be a chance to check in and offer support.
  2. Be a listening ear to your LGBTQ+ friends, family and peers and be someone who they can talk to when they are upset or distressed
  3. Respect identity by using preferred gender pronouns (i.e., he/she/they), name, and other terms – when in doubt, use neutral words (i.e., they, partner) or ask about preference
  4. Ask early and specifically about the presence of eating disorder symptoms if you are a health or mental health provider working with LGBTQ+ youth. Early intervention  leads to more positive recovery outcomes but many people don’t disclose disordered eating behaviors unless explicitly asked about them.
  5. Start an LGBTQ+ club at your school or workplace to demonstrate your support and to help spread awareness
  6. Volunteer for LGBTQ+ hotlines, such as the GLBT National Help Center or The Trevor Project
  7. Educate yourself on the relationship between stigma, discrimination and eating disorders and help spread the word about common myths and facts
  8. Remember the power of family connectedness as a protective factor. Create a welcoming home for your family members of all genders and orientations.

If you are a member of the LGBTQ+ community and you think that you may have disordered eating, or just want a judgement-free space to talk, call any of the following hotlines or visit https://www.eatingdisorder.org/letscheckin to take a free online self-assessment and get connected with treatment.


LGBTQ+ and Related Hotline Numbers

  • National Eating Disorder Hotline 1-800-931-2237
  • LGBT National Youth Talkline 1-800-246-PRIDE (7743)
  • LGBT National Hotline 1-888-843-4564
  • Sage LGBT Elder Hotline 1-888-234-SAGE (7243)
  • The Trevor Project (24/7) 1-866-488-7386
  • TrevorText (M-F 3pm-10pm) Text “Tevor” to 1-202-304-1200
  • The National Runaway Safeline 1-800-RUNAWAY (800-786-2929)
  • The True Colors Fund (homelessness) 1-212-461-4401

For more information about eating disorders and treatment options in Baltimore, visit eatingdisorder.org or call (410) 938-5252 for a free phone assessment.


Blog contributions by Catherine Pappano, CED Research Assistant 

You may also be interested in reading:

 


References

  1. Watson, R. J., Adjei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders, 50(1), 22-31.

  2. NEDA: Eating disorders in LGBTQ+ populations. https://www.nationaleatingdisorders.org/learn/general-information/lgbtq. Accessed June 22, 2018

  3. French, S.A., Story, M., Remafedi, G., Resick, M.D., & Blum, R.W. (1996). Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: A populationbased study of adolescents. International Journal of Eating Disorders, 19(2), 119-126.

  4. Mason, T.B., Lewis, R.J., & Heron, K.E. (2017). Daily discrimination and binge eating among lesbians: a pilot study. Psychology & Sexuality, 8(1-2), 96-103.

  5. NEDA: Eating disorders in LGBT (gay/lesbian/bisexual/transgender) populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdfAccessed October 31st, 2017.

  6. NEDA: Eating disorders in LGBT (gay/lesbian/bisexual/transgender) populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdfAccessed October 31st, 2017.

  7. Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: probability profiles from risk and protective factors. International Journal of Eating Disorders, 50,515-522.

Transition and Recovery with Ryan Sallans: A Reflection on TU’s Eating Disorder Awareness Week Event


What does it mean to live authentically? 

Honoring your truth.

In other words, understanding, accepting, and nurturing your various, intersecting identities, to live your best life. This was a major theme throughout a special event held in February at Towson University (TU) to help recognize National Eating Disorders Awareness Week.At the event, speaker Ryan Sallans shared his personal experience of gender identity development and eating disorder recovery with the TU community. Organized by TU’s Counseling Center, the event was well-attended and brought together various university and local organizations, including The Center for Eating Disorders at Sheppard Pratt, TU’s Center for Student Diversity and The TU Body Image Peer Educators (BIPE). Sallans is a well-known public speaker, author, and health educator, and has been featured on Larry King Live, NPR, The Advocate, and many other news and popular media outlets.

 

Documenting Self-Discovery through Transition and Recovery

Throughout his talk, Sallans highlighted the delicate balance between taking care of oneself and navigating important relationships that often change throughout transition. Of course, each individual’s experience is different and Sallans did well to emphasize his is only one story among many.

Despite transgender and gender non-binary identities being discussed more openly than ever, there remains a stark deficit in information regarding the intersection of body image, gender identity development, and eating disorders. Studies have suggested the prevalence of eating disorders is higher among transgender individuals when compared to the general population (Reisner et al., 2016; Watson, Veale, & Saewyc, 2016). This health disparity is likely influenced by the pervasive effects of transphobia in our society, which sets the stage for inequality and discrimination at home and beyond, creating unique risk factors for the trans community (Bockting, Miner, Swinburne-Romine, Hamilton, & Coleman, 2013; Watson et al., 2016).

Pair this with the fact that no one is immune to the influence of the multi-billion dollar beauty industry consistently sending a message that, in order to be happy, we must look a certain way. Each one of us, regardless of gender, is sold (to some extent) on the idea that by controlling our bodies, we can achieve happiness, wealth, and popularity. Those working in the eating disorder field have historically referred to this as the internalization of the “thin ideal” or the acceptance of unrealistic or narrow beauty standards (Thompson & Stice, 2001). Transgender individuals are not immune from this culturally normative body dissatisfaction.  But people with eating disorders who identify outside of the restrictive gender binary may also experience amplified body dissatisfaction because their gender identity and their sex assigned at birth do not match (Algars, Alanko, Santtila, & Sandnabba, 2012; Strandjord, Ng, & Rome, 2015).

Furthermore, adjusting to a changing body and gender expression (for those who opt for cosmetic, hormonal, and other gender-affirming interventions), as well as the public commentary this process often evokes, presents its own unique challenges that impact body image and self-esteem (Couturier, Pindiprolu, Findlay, & Johnson, 2014).

 

How does one survive, and thrive, when faced with such challenges?

Sallans encouraged everyone in the room that night to stay hopeful and connected, which for him means sharing life stories to better understand those that are different. His comments suggested tremendous patience and empathy for his loved ones’ process of arriving at a place of acceptance with his transition, while also emphasizing the need to disconnect at times to protect oneself. Sallans identified a number of strategies and resources he has found useful, starting with a non-judgmental awareness of his needs, his boundaries, and his triggers. He explored the role of psychotherapy, as well as self-guided research on lesbian, gay, bisexual, and transgender issues, in helping him to turn towards his inner truth and wisdom.

Consistent with national guidelines on psychotherapy with LGBTQ individuals, Sallans benefited tremendously from collaborating with an affirmative therapist; someone he was able to confide in during times of confusion and fear surrounding gender identity, at a time when very few were even considering gender outside of the binary. The trust and respect he built with his therapist created a safe space to discuss gender issues and eating disorders, which provided the platform for recovery and ultimately allowed for closer and more authentic connections with family and friends. Outside of therapy, Sallans said he found it incredibly useful to communicate about his emotions and take time out for himself. He acknowledged the need to unplug from negative relationships (and social media) and engage in routine self-care, which for him often includes going for walks and being in nature.

Self-care, use of coping skills for managing negative emotions, positive sense of identity and community, and feeling like you can count on those closest to you are universal factors associated with resiliency (Rutter, 2012). These factors are even more relevant for those who identify outside of the gender binary (Hill & Gunderson, 2015; Watson et al., 2016). If you or a loved one is struggling with an eating disorder and questioning gender identity, see the resource links below to gather information, find community, and get professional support.

 

For information regarding affirming and evidence-based treatment options and programs at The Center for Eating Disorders at Sheppard Pratt, please contact us at (410) 938-5252 or email us at eatingdisorderinfo@sheppardpratt.org.

 

Additional Resources:
https://www.ryansallans.com (Ryan Sallans’ Official Website)
www.genderspectrum.org
www.glaad.org
www.pflag.org
www.thetrevorproject.org
https://www.chasebrexton.org/our-services/lgbt-health-resource-center


Written By: Andrea Castelhano, PsyD, Outpatient Therapist – Dr. Castelhano is a licensed clinical psychologist in the outpatient department at The Center for Eating Disorders at Sheppard Pratt. She earned her doctorate in Clinical Psychology at the American School for Professional Psychology at Argosy University, DC where she received training in cognitive behavioral therapy and mindfulness-based approaches to psychotherapy. She also received specialized training in eating disorders, anxiety disorders, and co-occurring self-harm and suicidality. Additionally, she has provided affirmative therapy to individuals in the LGBTQ+ community throughout her training and professional career. Affirmative therapy is a therapeutic approach that respects individuals of all sexual orientations and genders, recognizes the impact of intersectionality on identity development and life experience, and addresses issues including discrimination and heterosexism as they relate to the individual’s broader treatment goals. Dr. Castelhano joined The Center for Eating Disorders in 2018 and brings her experience from a variety of clinical rotations, including a year-long practicum at Children’s National Medical Center Outpatient Eating Disorders Clinic,  APA-accredited clinical internship at Laureate Psychiatric Clinic and Hospital, and post-doctoral fellowship with the University of Tulsa Counseling and Psychological Services Center. She provides individual, family, and couples therapy, as well as psychological testing services. She is fluent in Spanish and Portuguese.


References

Algars, M., Alanko, K., Santtila, P., & Sandnabba, N.K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders: The Journal of Treatment & Prevention, 20, 300-311.

Bockting, W.O., Miner, M.H., Swinburne-Romine, R.E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943-951.

Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N. (2014). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating Disorders, 48, 151-155.

Hill, C. A., & Gunderson, C. J. (2015). Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychology of Sexual Orientation and Gender Diversity, 2, 232-252.

Reisner, S.L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, … Baral, S.D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388, 412-436.

Rutter, M. (2012). Annual research review: Resilience – clinical implications. The Journal of Child Psychology and Psychiatry, 54, 474-487.

Strandjord, S.E., Ng, H., Rome, E.S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. International Journal of Eating Disorders, 48, 942-945.

Thompson, J.K. & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181-183.

Watson, R.J., Veale, J.F., & Saewyc, E.M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50, 515-522.