Understanding Risk Factors When Supporting LGBTQIA+ Individuals with Eating Disorders
Blog Post by Contributing Editor Barry McNinch, MS, LPC
Eating disorders don’t discriminate, they affect people of all genders, sexualities, and identities. But for those in the LGBTQIA+ community, these struggles often come with an added layer of complexity. In my work as a therapist, I’ve seen how essential it is to not only address the eating disorder itself, but to understand the role it played for the individual behind it—their identity, their experiences, and their truth. Understanding the interweaves of how the eating disorder started as a locus of control, a false sense of protection, allows for us to support through a trauma-informed lens of seeing their eating disorder as an adaptive coping skill to a mal-adaptive coping skill. While engaging in this work with LGBTQIA+ clients, it is imperative to affirm the client as a whole person, as many parts of a person’s self has developed to get to their current place in life.
For LGBTQIA+ individuals, the path to healing often requires navigating a world that hasn’t always felt safe or accepting. Creating a therapeutic environment that is inclusive, compassionate, and attuned to the unique needs of LGBTQIA+ clients can make all the difference. Let’s take a closer look at how we can do that—starting with understanding the scope of the issue.
Recognizing the Reality: Eating Disorders in the LGBTQIA+ Community
Eating disorders in LGBTQIA+ populations are far more common than many realize. While research in this area has historically focused on straight, cisgender women, emerging studies show that LGBTQIA+ individuals are experiencing eating disorders at disproportionately high rates. In one national survey, over half of LGBTQIA+ adolescents and young adults reported having been diagnosed with an eating disorder, and another 21% suspected they had one. Among males with eating disorders, 42% identified as gay, despite gay men making up just 5% of the general male population (x). Across sexual minority groups, there are consistently elevated rates of binge eating, purging, and body image distress.
These numbers tell a clear story: eating disorders are not confined to any one demographic. They thrive in silence, in shame, and in systems that fail to see or support the full spectrum of human identity. The LGBTQIA+ community deserves care that acknowledges these realities and meets people where they are.
Understanding the Risk: What Puts LGBTQIA+ Folks at Greater Vulnerability?
The development of an eating disorder is never the result of one single cause. It’s mixed experience where the antecedents include variables ranging from biology, psychology, environment, to lived experiences. When we look specifically at LGBTQIA+ individuals, certain risk factors stand out, often stemming from the painful intersections of identity, marginalization, and trauma.
For many, the challenges begin early. Coming out can be a powerful and liberating experience, but it’s also often filled with anxiety, fear of rejection, and, sometimes, actual loss—of family, friends, housing, or safety. Trauma from these ruptured attachments can plant seeds of shame that grow quietly over time, diminishing self-worth and distorting one’s relationship with their body (x). It’s not uncommon for people to internalize harmful messages they’ve heard from others, believing they are somehow broken or not enough.
Body image issues are especially prevalent in the LGBTQIA+ community, with distinct experiences across identities. Gay men often face intense cultural pressure to attain lean, muscular physiques, which can fuel body dissatisfaction and disordered eating. Lesbians may struggle with conflicting societal and community standards around femininity, weight, and desirability, often leading to self-worth being tied to body size.
When supporting transgender and non-binary clients, it is important to understand how body dysmorphia and gender dysphoria can become entangled, where distress about physical appearance is deeply connected to incongruence between one’s body and gender identity. These complex dynamics underscore the importance of affirming, individualized support that addresses both body image concerns and the unique intersections of identity. For transgender and gender-nonconforming individuals, eating disorders can sometimes be a way to manage gender dysphoria, or regain a sense of control in a world that doesn’t always see them clearly.
Lack of support only compounds these struggles. Far too many LGBTQIA+ youth face unsafe home environments or homelessness after coming out. LGBTQIA+ youth experience higher rates of bullying, both in-person and online. This compounded bullying leads to chronic stress, low self-esteem, and emotional distress. This persistent victimization increases vulnerability to developing eating disorders, as disordered behaviors may emerge as a way to cope with pain, regain control, or alter one’s appearance to avoid further targeting (x). For many, the trauma of bullying becomes deeply woven into the development and maintenance of the eating disorder, highlighting the need for trauma-informed, affirming care. Without stability or affirming care, it becomes even harder to build the kind of self-compassion and resilience that recovery demands.
Conclusion
Supporting LGBTQIA+ individuals with eating disorders requires more than treating symptoms, it calls for affirming care that honors identity and lived experience. Understanding the unique risk factors LGBTQIA+ clients face, such as discrimination, dysphoria, and body image pressures, is essential in guiding compassionate, trauma-informed work. When we create space for clients to feel seen as a whole person, client’s can engage in recovery in all of their parts of self.
Barry McNinch, MS, LPC
Rock Recovery Board Member
About the Contributor: Barry McNinch joined the Rock Recovery Board in October 2022, and has been a dedicated Rock Recovery supporter and volunteer for years. As a Licensed Professional Counselor, Barry specializes in helping young and mature adults navigate challenges related to eating disorders, substance use disorders, personality disorders, and mood disorders. He takes pride in working with the LGBTQIA+ community, and understands the need to create a space for those navigating the very complex process of connecting to our own identities. Barry excitedly uses his passion for mental health to help Rock Recovery serve more individuals in the community.