LGBT youths report eating disorders at stunning rate

Because health concerns in the LGBT population generally are considered to be an under-researched topic, the release of any comprehensive data in this area rarely escapes notice in the professional community. In the case of results of a newly released survey on eating disorders among LGBT young people, however, these fresh numbers are both noteworthy and utterly staggering.

Cosponsored by the National Eating Disorders Association and unveiled as part of the annual awareness week activities that it spearheads in February, the survey of more than 1,000 young people ages 13 to 24 found that more than half (54%) had received an eating disorder diagnosis at some point in their young life. Moreover, of those individuals who had not received this diagnosis, 54% said they suspected they had an undiagnosed eating disorder.

Such numbers did not appear to surprise Philip McCabe, a health educator at the Rutgers University School of Public Health and president of NALGAP, The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies. However, McCabe tells Addiction Professional, “As a trainer on LGBT issues I find many clinicians are surprised when I share information on eating disorders with gay and bisexual youth.”

McCabe adds, “This raises several areas of concern—first, not all addiction professionals have received training on eating disorders. Unless the client self-discloses, it is not always included during the assessment.”

What the numbers show

The online survey also was conducted by Reasons Eating Disorder Center and The Trevor Project, the latter being an organization seeking to end suicide in the LGBT population. It took place from early January to early February and included individuals identifying as a sexual orientation other than heterosexual and/or a gender identity other than cisgender, which is defined as identifying with one's gender of birth. A detailed questionnaire explored disordered eating diagnoses and behaviors, as well as any history of suicidal ideation or behavior.

The survey found that transgender youth face a disproportionate risk of having an eating disorder, with 71% of transgender respondents who identify as straight having been diagnosed with an eating disorder. However, cisgender LGBTQ females (the Q stands for both queer and questioning in the survey) reported the highest prevalence of eating disorder diagnoses of any gender identity in the survey, at 54%. By comparison, the prevalence of eating disorders among cisgender males was 31%, and the prevalence of eating disorders among transgender females was 12%. A total of 39% of transgender males reported an eating disorder diagnosis.

The researchers reported that across all subpopulations in the survey, the most common habits of disordered eating were fasting, skipping meals and eating minimal amounts. Bulimia was the most common eating disorder diagnosis that cisgender and transgender females had received.

The survey also illustrated a close link between the presence of an eating disorder and suicidality. Responses indicated that 58% of LGBTQ youths who had been diagnosed with an eating disorder have considered suicide. Suicidal thoughts were more common among young people who had been diagnosed with bulimia, the researchers reported.

An introduction to the survey document from Amit Paley, CEO of The Trevor Project, states that the findings “are alarming and highlight the need for further research to improve the lives of LGBTQ young people in this country.”

Correlations go unrecognized

“There is a correlation between body dysphoria, poor body image, combined with how individuals who experienced trauma and minority stress, that is not always understood,” says McCabe in reaction to these findings on eating disorders in the young LGBTQ population. He adds, “This survey helps to shed light on the greater health risks of LGBTQ youth and young adults.”

Paley adds in the survey document, “The unique stressors that LGBTQ-identified people experience, such as coming out and harassment in schools or the workplace, can impact levels of anxiety, depression, low self-esteem, and unhealthy coping mechanisms such as substance abuse. All of these can be contributing factors in the development of an eating disorder and are common co-occurring conditions.”

McCabe says that in discussing findings such as these, he often calls attention to a 2014 American Academy of Pediatrics study showing that gay and bisexual teen males use illicit steroids at a rate almost six times higher than straight teens.

McCabe suggests that clinicians who work with LGBTQ patients don't always grasp the full range of behavioral health issues that can be related to the experience of minority stress in this population. “Knowing how to address the concerns with LGBTQ affirmative and comprehensive evidence-based interventions requires specific training,” he says.