Eating Disorders and LGBT Youth

by聽Chase Bannister

So, is it nature or is it nurture?

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Eating disorders are the most lethal of all mental illnesses, and affect more than 25 million people in the United States.聽 To be redundant because it’s important, these illnesses鈥擜norexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and unspecified eating disorders 鈥攈ave taken the lives of too many wonderful young people, and continue to do so.

Many colleges and universities have been aware of the prevalence of eating disorders for some time, and have been doing what they can.聽 Of course, in the absence of adequate funding for sufficient research, common lore reigns.

With myth as prevailing truth, eating disorders were (and often still are) imprudently narrated as illnesses as disorders of will, disorders of choice, and disorders of the affluent straight white girl.

I’m credentialed as a Certified Eating Disorder Specialist (CEDS), having spent the last nine years resolutely and unapologetically fixated on best-practice care for persons with eating disorders, and am co-founder of Veritas Collaborative, a specialty behavioral health hospital for young people with eating disorders. Addressing and healing eating disorders is incredibly important to me.

Collaborative efforts in the academic and clinical practice communities point to an alarming reality鈥攐ur societal failure to acknowledge the enormity of eating disorders within the LGBTQ community. 聽Yep, I meant it to sound bold like that.

路聽聽聽聽聽 Compared to straight males, gay males are significantly more likely to restrict food, purge by vomiting or laxatives, compulsively exercise, and take diet pills to control weight.

路聽聽聽聽聽 Approximately 6% of males identify as gay in the US; yet gay males represent 42% of males with eating disorders.

路聽聽聽聽聽 Gay males appear to be at particular risk due to intra-community pressures to be muscular and thin at the same time.

路聽聽聽聽聽 Loneliness is an understudied and significant risk factor for gay males; those not in a (self-described) significant romantic relationship appear to engage in dramatically more鈥攁nd more severe鈥攊nstances of eating disorder behaviors than those in relationships.

路聽聽聽聽聽 Lesbian women were once considered “protected” from eating disorders because of the community’s perceived rejection of the feminine norm, yet now we know that lesbian women are just as likely to have an eating disorder as straight women.

路聽聽聽聽聽 Lesbian women with body image distortion, disordered eating, and/or eating disorders are “doubly isolated within the lesbian community. And isolation perpetuates the problem.” [Naomi Tucker]

路聽聽聽聽聽 Trans people report significant body dissatisfaction along with severe dieting, fasting, and purging behaviors.

路聽聽聽聽聽 Only 35% of medical curricula include any information on endocrine/hormonal/medical issues related to gender transition.

路聽聽聽聽聽 LGBTQ persons are at higher risk for depression, anxiety, and substance abuse disorders than straight persons (co-morbid risk factors for eating disorders)

路聽聽聽聽聽 LGBTQ persons people are 2.5 times more likely than their heterosexual peers to have had a mood, anxiety, or substance abuse disorder in their lifetime (more co-morbid risk factors for eating disorders)

Moreover, we know that eating disorders鈥攃omplex disorders that live at the intersection of nature and nurture and the intersection of physical illness and mental illness鈥攃an start out as ways to cope with the stress, stigma, and shame heaped upon them (a concept called “minority stress”).聽 LGBTQ persons might engage disordered eating behaviors as:

鈥⒙犅犅犅犅犅 A way to manage difficult and ambivalent feelings about being LGBTQ and/or being out

鈥⒙犅犅犅犅犅 A way to mitigate and control feelings about one’s gender or gender expression

鈥⒙犅犅犅犅犅 An identity to hold onto while LGBTQ identities may yet be amorphous, i.e. I am my eating disorder

鈥⒙犅犅犅犅犅 A response to trauma, in whatever form or forms that might take

鈥⒙犅犅犅犅犅 A way of coping with the anxiety around the body-as-currency or body-as-value

鈥⒙犅犅犅犅犅 A means of attaining a masculine or feminine ideal

It’s important to remember here that we believe eating disorders have a nature/nurture component to them, too.聽 Clinically, we understand eating disorders as remarkably complex, biogenetically-mediated mental illnesses.聽聽 That is to say, some persons may be genetically hard-wired for an eating disorder illness; absent purging or restricting or compulsively exercising, the illness might remain practically dormant, and the person may never experience the torment of an eating disorder.

All this theory is truly important to the LGBTQ community.聽 What might seem like an inconsequential behavior鈥攕ay, restricting foods or food groups鈥攎ay inadvertently trigger a long-term struggle with an eating disorder.

I believe we have a chance to do things differently鈥攁 chance to potentially prevent our peers from having to experience this kind of pain.

And it starts with us.聽 Whether we’re in the therapy room, the classroom, the cafeteria, the library, or hanging out at the corner coffee shop鈥攚e can be mindful of how we talk about our bodies, and how we talk about other people’s bodies.聽 Given everything LGBTQ folks have to face during high school, college, and young adulthood, the absolute last thing they need is for their own community to be participating in the criticizing, critiquing, and shaming of bodies.

It’s awesome to witness the swift progression of LGBTQ rights before our very eyes.聽 Yet there’s much left to be done 鈥 and so many people still left in the shadows.聽 Not-so-shockingly, researchers found that when LGBTQ young people feel accepted by their families, they were much more likely to believe they would have a good life鈥攁nd that they would have a happy, productive adulthood.
Want a protective factor from an eating disorder for an LGBTQ person?聽 Help them know that they are special, that there’s no one else in the聽 world like them, that they enrich our lives by their just being themselves, that their feelings are mentionable and manageable, and that they are wonderful and lovable just the way they are.

Chase Bannister, MDIV, MSW, LCSW, CEDS
Vice President & Chief Clinical Officer,
Veritas Collaborative

Veritas Collaborative is a Specialty Behavioral Health Hospital for Young People & Center of Excellence for the Treatment of Eating Disorders, located In Durham, North Carolina.

To learn more about the聽National Eating Disorders Association (NEDA)聽and to view the聽Eating Disorders in the LGBTQ Community聽NEDA webinar, please visit聽www.nationaleatingdisorders.org.

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