As a cisgender, Caucasian female in recovery from an eating disorder, I'm all too aware that I fit the bill for what we presume is the stereotypical eating disorder patient. So often in movies and TV shows that is all that is shown, so it never surprises me when others are surprised at the various ways eating disorders show up in different cultures and minority communities.
Humans are dynamic in all our little ways, and each of us is susceptible to an eating disorder existing in the world that we do, surrounded by media influence and cultural preferences of what beauty “looks like” within our communities.
With this in mind, I set out to speak with eating disorder specialists about what minority group is affected most by eating disorders. As a member of the LGBTQ community, it did not surprise me to hear it is our minority group disproportionately plagued, specifically trans youth. I am a bisexual woman who is often assumed to be heterosexual based on the way I dress and appear. So, in essence, I understand to some degree how eating disorders can manifest as we come to terms with our sexuality, gender, etc., in a world where it can be difficult to be different from the masses. We cope as we are able, which can develop into negative coping behaviors — such as an eating disorder.
Let's take a look at why our community can be vulnerable to eating disorders and what we can do about it.
Behind this connection
According to Dr. Ashley Solomon, a psychologist and regional managing director of telebehavioral health division at the Eating Recovery Center in Ohio and South Carolina, “Studies have shown that compared to their cisgender counterparts, trans youth in particular are more likely to engage in unhealthy fasting, using diet pills and steroids and taking laxatives. In fact, the risk is about four times greater in this population of individuals.”
The reasons for this increased vulnerability are complex, and no one can point to one particular cause, she tells SheKnows. Oftentimes, Solomon explains, it’s assumed that the eating disorder develops because someone undergoing transition may be uncomfortable in their body and starts using behaviors to try to change their body, such as in an effort to be thinner or what is more traditionally accepted as feminine.
Another major psychosocial explanation derives from minority stress theory, which has demonstrated that the drive for unhealthy, problematic behaviors found among LGBTQ individuals are the result of the chronic social stress they experience due to their sexual minority status, Dr. Norman H. Kim, the national director for program development at Reasons Eating Disorder Center, tells SheKnows.
Significant stressors — like those associated with a history of microaggressions, discrimination and marginalization, stigmatization and social rejection, bullying and teasing, harassment and physical violence, not to mention rejection from one’s family of origin and/or community — can all lead directly to behaviors such as disordered eating, Kim adds.
Exposure to stigma, discrimination and rejection has been clearly tied to negative effects on both physical and mental health as well as on self-esteem, which is another key risk factor in the development of eating disorders, Solomon notes.
“It’s still often more complicated than that,” she explains. “In particular, a personal and cultural history of social stigma and discrimination is a major risk factor for developing mental health challenges, including eating problems. For someone who has the genetic makeup to be at risk for an eating disorder, bias, bullying, family rejection and an overall hostile world can tip the scales, so to speak, and lead to dangerous eating disorder symptoms.”
I also wondered if there were added physical and emotional dangers for someone who is in the process of transitioning. According to Kim, one of the more complicated treatment issues to navigate with someone who is transitioning and who has an eating disorder is that while on the surface, both involve dissatisfaction with one’s body, the goal and process of treatment is quite different.
“Supporting the trans identity of the [transgender] person through hormone therapies, reassignment surgeries or other transitions is affirming and an important, necessary part of working with that person and helping them heal,” Kim says. “In contrast, healing from an eating disorder involves not engaging in potentially lethal eating disorder behaviors and letting go of that identity in service of reconnecting with one’s true self.”
Understanding the treatment
Treating a person who is transitioning and also living with an eating disorder is no simple task, and as I pressed the experts on how they service and help those who are undergoing both, it was clear that there is still a lot of work to be done but that eating disorder specialists around the country and world are dedicating resources and their time to working on the unique treatment plans for those affected.
“The greatest danger is that in the eating disorder treatment community, just like most of the medical and psychological communities, there is very little understanding of how to work with [trans] people,” Kim says. “Finding eating disorder specialists who also have experience working with the trans population is essential but can be challenging, although we are seeing increasing efforts to correct this in our field."
The most important question we have to ask ourselves is "What can we do to help support someone undergoing transition if they live with an eating disorder as well?"
“Recognize that this is not a choice that a friend is making to be difficult or often even to change their body,” Solomon says. “Eating disorder behaviors generally develop as a mechanism for coping with seemingly unmanageable feelings and stress."
She also recommends being present and available to support them and to allow them to practice healthier ways of connecting.
"Keep in mind that most people will need professional support and direct them to support and services," she adds. "Know that you won’t be able to solve this for them, but there are effective treatments that work.”
If you or someone you love needs help with an eating disorder, contact Walden Behavioral Care toll-free at 888-791-0004 for a free confidential consultation. Walden is a safe, supportive and inclusive facility for those who are LGBTQ.