Eating disorders are highly complex brain disorders that emerge out of a constellation of different factors, including genetics, biology, environment, and more. However, LGBTQIA+ folks face a variety of unique challenges that increase their likelihood of developing an eating disorder. Those challenges include:

• Stigma and discrimination. Society often sends LGBTQIA+ people the message that their bodies and core identities are unacceptable or unimportant, which can come through as overt discrimination, subtle microaggressions, or rejection from loved ones. All of this can contribute to a feeling of alienation and lack of acceptance, and eating disorder behaviors may emerge as a way to cope with these feelings.
• Past trauma or PTSD. Members of the LGBTQIA+ have increased rates of trauma, which is known to significantly increase the likelihood of developing an eating disorder.
• Unrealistic body ideals. While society at large promotes unrealistic and unhealthy body ideals, this may be more pronounced within certain LGBTQIA+ communities. This may be particularly true among gay men and boys. For transgender people, there is additional, safety-related pressure to attain narrow appearance ideals.
• Uneducated providers. Because many healthcare providers lack knowledge about eating disorders in LGBTQIA+ populations, transgender and queer folks who are struggling often go undiagnosed, allowing their eating disorder to become more entrenched.
• Gender dysphoria. Gender dysphoria is when someone feels significant distress, discomfort, or misalignment with their body experience. To deal with gender dysphoria, some LGBTQIA+ youth may restrict food in an effort to prevent or delay the development of sexual characteristics—like chest tissue, menstruation, or body hair—that don’t align with their gender identity. Eating disorder behaviors can also emerge as a way to cope with the intense negative feelings associated with gender dysphoria, which is more likely to happen if the dysphoria goes untreated (an outcome that’s unfortunately common for trans and nonbinary people).

In addition to being at a heightened risk for developing an eating disorder, LGBTQ+ people also face barriers to effective treatment. Some of the challenges they might encounter include:

• Lack of provider education. Unfortunately, not many healthcare providers are knowledgeable about eating disorder risk in LGBTQ+ populations and the importance of gender-affirming care. This might mean that patients go undiagnosed or even face discrimination. This lack of education can be particularly harmful fortrans patients, who might come up against “trans broken arm syndrome,” which is when serious health issues (like eating disorder symptoms) are chalked up to their gender journey. Some providers might even gatekeep gender-affirming treatments because they believe that the patient’s desires are stemming from the eating disorder.
• Lack of research. Most eating disorder research looks at white, cisgender females. And while more research is being done on eating disorders in LGBTQIA+ populations, the standards of care and the most frequently used measurement tools to assess eating disorder severity are still based on predominantly white, cisgender, and heterosexual samples.
• A hostile legal environment. Anti-trans and anti-LGBTQ+ legislation can increase barriers to proper healthcare, including eating disorder treatment, as well as exacerbate many of the factors that increase risk of eating disorders in this population.
• Estranged family. For some LGBTQIA+ folks, protecting their mental health means distancing themselves from their family or experiencing rejection from their family of origin. Because of that, they often lack the emotional and financial safety nets that someone living at home with their parents likely has.

Given all of these challenges, your support is crucial to any LGBTQIA+ loved one who may be struggling with an eating disorder. Here are some tangible ways to help:

• Validate their identity. Use their pronouns and wholly embrace their gender identity and sexual orientation to send the message that they are accepted and their life is worth fighting for.
• Be their advocate. In a healthcare environment that often sidelines their experience, vocal advocates can be a huge help to LGBTQIA+ people. That might mean advocating for them to healthcare providers, insurance carriers, or even family and friends.
• Help them find gender-affirming care. For trans and nonbinary folks, gender-affirming treatment is non-negotiable criteria for achieving recovery. Help your loved one do the research and make the phone calls to find treatment that will validate their identity.
• Be there. By simply showing up, you can help your loved one feel less alone, safer in their body, and more motivated to seek treatment. Make your concerns known in a curious and gentle way, and be proactive in initiating conversations and helping them seek care.

While every person has unique desires and life circumstances, the answer to this question is generally yes. Eating disorders don’t exist in a vacuum, and it’s important for treatment teams to have a comprehensive sense of what’s going on in a patient’s life, which includes their gender identity and sexual orientation.

It’s also important to discuss these topics to ensure that patients are able to access gender-affirming care. Gender-affirming care is an approach to treatment that respectfully affirms a trans patient’s gender identity, taking into account all the physical, mental, and social aspects of their well-being. Gender-affirming care often starts as a simple conversation, where a patient and their providers discuss what pronouns the patient uses and whether that differs by setting, what their gender identity means to them, and what challenges they’ve faced or are facing. By understanding a person’s whole experience and incorporating it into their treatment, providers can better support patients in moving toward recovery.