Why eating disorders affect LGBT+ people more

When people picture someone with an eating disorder, many think of a thin, teenage girl with anorexia nervosa. This stereotype is so pervasive it can feel like a fact.

The reality is that eating disorders affect people of all ages, body sizes, cultures, races, sexes, genders and sexualities. In 2023, around 1.1 million Australians (around 4.5% of the population) were living with an eating disorder.

A growing body of evidence suggests LGBTQIA+ people are particularly vulnerable to developing eating disorders. But we still need more research to understand how and why they affect this group more.

Here’s what we know so far about LGBTQIA+ people’s higher risk – and what treatment actually works for them.

What is an eating disorder?

Eating disorders are serious mental health conditions that affect a person’s eating behaviours. They can harm both physical and mental health.

Anorexia nervosa and bulimia nervosa are the most well-known eating disorders, but the most common are actually binge eating disorder (eating a lot in a short amount of time and feeling out of control) and avoidant/restrictive food intake disorder (restricting eating because of sensory sensitivity, lack of appetite, or fear of illness or choking).

Eating disorders can cause damage to a person’s organs, bones, fertility and brain function. People with an eating disorder are up to five times more likely to die early than those without one.

How much higher is the risk for LGBTQIA+ people?

Research shows that LGBTQIA+ people have much higher rates of eating disorders than non-LGBTQIA+ people.

For example, in the United States, an estimated 9% of the population will experience an eating disorder in their lifetime. But a 2018 survey of LGBTQ young people in the US found rates were significantly higher:

Within the LGBTQIA+ community, the risk also varies across different groups:

We don’t have data for asexual people, but we do know that asexual people have poorer body image than their non-asexual peers. So it is likely they also experience higher rates of eating disorders.

Why LGBTQIA+ people face higher risk

Being an LGBTQIA+ person is not a mental illness. There is no evidence of a biological reason why LGBTQIA+ people experience higher rates of eating disorders.

While many factors contribute, two of the most studied risk factors are minority stress and gender dysphoria.

1. Minority stress

Minority stress refers to how discrimination and stigma negatively impact the health of LGBTQIA+ people. This means it is not who they are, but how LGBTQIA+ people are treated that drives their higher risk.

Discrimination can lead LGBTQIA+ people to feel shame about their identities and bodies. Some people try to cope through disordered eating behaviours, which can develop into an eating disorder.

For intersex people, medically unnecessary surgeries in childhood to “normalise” their bodies can cause trauma and shame that can also increase eating disorder risk.

2. Gender dysphoria

Many trans people experience something called gender dysphoria. This is the distress, discomfort or disconnect that can happen when a person’s gender identity doesn’t match their physical body or how others see them. For many trans people, eating disorders can be an attempt to reduce gender dysphoria.

In trans teens, eating disorders often develop as a way to stop puberty when they can’t access puberty blocking medications. For example, restricting food may be a way to try to reduce the appearance of breast tissue or to stop having periods.

What kind of treatment would work?

After a diagnosis, typical eating disorder treatment involves a multidisciplinary team including a doctor, mental health professional and dietitian. Treatment can be provided in the community or in a hospital if someone’s physical health needs close monitoring.

But eating disorder treatment was not designed with LGBTQIA+ people in mind and can sometimes cause harm. LGBTQIA+ people report more negative experiences of treatment compared to the general population.

For example, mirror exposure exercises are a common therapy, where someone with an eating disorder is asked to look in a mirror for prolonged periods to lessen their body image distress. But for some trans people this can worsen their gender dysphoria.

This doesn’t mean treatment can’t help LGBTQIA+ people. It means treatment has to be adapted to ensure it meets their needs.

In practice, this might look like:

If this article raised any concerns for you or someone you know, contact the Butterfly Foundation on 1800 33 4673. You can also contact QLife at 1800 184 527.