Eating Disorders and Queer Identities: Understanding the Connection

Guest Blog Post:

Christine Ruberti-Bruning, ATR-BC, CEDS, LPC

Christine is a queer, licensed therapist and board-certified art therapist with over 15 years of experience providing therapy to LGBTQ adults and teens. She is a Certified Eating Disorders Specialist with advanced training in trauma, OCD, and gender-affirming care. Christine is a Level 1 IFS therapist and is trained in ERP.  

As a queer therapist who’s been on the journey of finding peace with food, the pressure to blend in is very real. As a cis woman, I was socialized to be accommodating and easy-going. My queerness got buried under a desire to feel seen and valued, which unfortunately got caught up in my body size. The striving for thinness can take up so much space that it’s easy to lose sight of who you are. It took years before I was ready to come out, and an extra push from my transitioning spouse. 

Many queer and transgender folks grow up feeling that pressure to “perform” an identity that doesn’t align with their core self. Some trans folks deal with this by performing the gender they were assigned at birth, rather than the gender that feels true to who they are. Transphobia and rigid gender expectations can put queer folks on high alert which can lead to an over-emphasis on appearance and how they are perceived. It’s no wonder disordered eating and body image issues are so prevalent in the LGBTQ population. 

Eating disorders are not just individual issues rooted in genetic predisposition but exist in our larger socio-political context. Eating disorders are not just about food but are also about feeling a sense of control and a way to cope with shame. They affect people across all genders, sexualities, body sizes, and race. People who hold marginalized identities are even more vulnerable to developing an eating disorder, yet they are severely under-represented in the research literature. 

Why LGBTQ+ Individuals May Be at Higher Risk for Eating Disorders

Eating disorders are complex mental health conditions that can lead to serious health complications including malnutrition and an increased risk of suicidality. Anorexia is one of the deadliest psychiatric issues, second only to opioid-use disorders.  

Chronic Minority Stress and Transphobia

Discrimination, rejection, and microaggressions are some of the experiences that put queer people more at risk for developing an eating disorder. People with marginalized identities are prone to fixate on how other people perceive them to fit in. The anti-trans legislation in the current US administration is making the world more unsafe for queer people. Some of trans folks are afraid to leave their house or use a public bathroom, and rightfully so. The chronic stress of having to be so vigilant can raise cortisol levels leading to anxiety, depression, and sleep issues. Some queer folks will avoid going to doctor’s appointments or visiting friends, leading to more health issues and feelings of isolation. 

Gender Dysphoria and Passing

Everyone’s gender journey is different, and some transgender folks have a complicated relationship with their body. Some people may feel discomfort in their body because it doesn’t align with their gender. Wanting to “pass” as cisgender can be a way to alleviate gender dysphoria and feel safer going out in public.  Passing can allow some trans people to feel more comfortable doing to a restaurant or a doctor’s appointment without feeling targeted. 

Eating disorders can play in a role in wanting to achieve a body that “passes” even if the mental health cost is high. Gender presentation can play a role in disordered eating, which gets even murkier. Achieving a certain body type can feel like a way to either feminize certain features or present as more masculine. I do my best to hold space for my clients’ feelings around their gender with curiosity and compassion. 

Pressure to conform to body ideals within certain LGBTQ+ spaces

The pressure to be thin, white and straight dominates the mainstream, but queer people face their own pressures in the community. Gay men face unrealistic pressures to look lean and muscular and are more at risk for developing body dysmorphia. The pressure to “pass” can also come from queer and trans spaces, as well as gatekeeping anyone who doesn’t neatly check a box. 

Queer people are already under-represented in the media, especially folks who are in a larger body, BIPOC, and don’t fit neatly into the gender binary. Non-binary individuals and bisexual people can face rejection from other queer folks with the message that they are not “trans or queer enough”. Whiteness can also dominate queer spaces and perpetuate a certain type of ideal queer aesthetic that can alienate a lot of people. 

Shame and Disconnect

Unfortunately, a lot of queer people face loss and rejection, whether it’s being fired from their job for being trans or being disowned from their families. Even growing up in a town as the only queer or trans person can lead to internalized shame and feelings of loneliness. Shame can lead to disconnect with your body and feelings of low-self-worth. Certain disordered eating behaviors like calorie counting, over-exercising, and binging can be ways to numb and distract from shame. 

Eating Disorders Don’t Look the Same for Everyone

Eating disorders are often shown as only impacting thin, white, cis woman. Even the research focuses on this population, with minimal literature the impact of eating disorders in BIPOC and LGBTQ communities. The lack of awareness exists on a societal level, leading to minimal screening for eating disorders in healthcare settings. Diet culture and fat phobia cause eating disorders to fly under the radar for people in larger bodies. Healthcare providers might recommend weight loss to a person in a larger body without screening for an eating disorder, nor addressing their actual health concerns. Research shows that people of any size can experience health complications from restrictive eating disorders. Diet culture normalizes under-eating so much that struggles like obsession with “clean eating”, calorie counting, and over-exercising go unnoticed by healthcare providers. The rise of Ozempic and GLP-1’s has only made this harder. 

Queer and Trans Teens

Queer and transgender teens are at a significantly higher risk for eating disorders and suicide compared to their straight, cisgender peers.  Bullying and discrimination put young people at higher risk for disordered eating and are more prone to body dissatisfaction. LGBTQ teens are vulnerable because they have to navigate a variety of settings, they don’t have control over. The level of safety and inclusion is dependent on the adults who oversee those spaces. Some queer teens don’t feel safe coming out to their families, or they have, but the experience was negative. Schools are also important setting that can either be a safe space for LGBTQ youth or contribute to the harm. 

Young people are exposed to social media which can lead to comparison culture and online groups such as Pro-Ana and Looksmaxxing. Even the rise of GLP-1 ads can have a major impact whether they are specifically targeting teens. On the health side, teens are still growing and developing, making the health risks of eating disorders even more catastrophic. 

When I work with teens, I strongly recommend that families add a dietician and pediatrician who specialize in eating disorders to their treatment team, if they haven’t already. Falling off the growth chart and malnutrition can cause medical decline much faster in children and teens. 

What Healing Can Look Like

One question I like to ask my trans clients is how much of their body discomfort is related to their gender and how much of it is coming from external messaging. What would it feel like if our world was truly trans centered, gender expansive, and safe? What if size diversity was celebrated and folks in larger bodies were seen as desirable on a societal level? How would they feel about their bodies then? For many folks, the source of their distress is both macro and personal. Some trans folks might feel a lot better in their bodies but still want to change their body if it doesn’t align with their core gender.  

Finding clarity on where body image stress comes from can be helpful in finding ways to cope. For some transgender people, it’s focusing on aspects of their appearance they can change that are also safe. That can be gender affirming surgeries, HRT, clothes, and hair. The parts of their appearance that they can’t change, we focus on processing those feelings and learning to cope with that discomfort.  

Gender as Core Self

The idea of your gender identity emerging from your core is another theme I like to explore with my clients. What are the aspects of their core self and how do they intersect with their gender identity? We might explore their values, hobbies, style, and personality traits that are independent of their body size. The goal is to provide a space that validates queer people’s feelings around their body while also helping them notice that their worth isn’t defined by their size. 

Recovery as an act of rebellion 

Finding incongruence between your values and diet culture can also help you move away from self-blame and hold the systems in our world accountable. Societal pressures will still affect you, but you might have a stronger foundation of self-trust to rely on.  

Body Acceptance is Still Out There (Yes, even on social media)

It can feel like you’re the only one that is disheartened by the state of our country and the rise of skinny culture. I feel a huge sense of relief when I not only get to talk about my feelings but also feel validated from others who share my values. You can find this kind of support in real life and online through podcasts and social media. Curating your social media feed can help balance out the constant diet talk and noise. We need to surround ourselves with voices that are pushing back against skinny culture more than ever. It can help us feel less alone and more empowered.

Beauty standards and gender are social constructs that have conditioned us to see certain traits as more attractive than others. When we surround ourselves with more diversity in gender expression and body types, we challenge some of that conditioning. Certain qualities may become more normalized and attractive. I truly believe this because I’ve experienced this myself. We were not born with fat phobic, racist, nor transphobic thoughts. We were taught those through societal conditioning. While it takes ongoing work, you can unlearn these messages and connect with what is important to you. 

How LGBTQ+-Affirming Therapy Can Help

Therapy can help you work through all your complicated feelings around your body and build confidence in who you are. Healing doesn’t need to be done perfectly, and you don’t have to love your body to find peace. 

Eating disorder therapy involves building a team of providers and loved ones that you trust. This can include a registered dietician who specializes in eating disorders who can provide direct support around food. If you struggle with other mental health issues, a holistic psychiatrist can be asset to your treatment team, especially if you’re taking medications.

A primary care doctor who specializes in eating disorders is highly recommended to track the medical side of your journey. As an eating disorder therapist, I work closely with your doctor to provide comprehensive support.    

Conclusion 

Looking for LGBTQ affirming support? My practice is rooted in weight-inclusive care and queer centered experiences. I provide art therapy, IFS, and ERP for adults and teens with eating disorders, OCD and trauma. You can click here to learn more about my practice.