In this article, I chose to use the word ‘queer’ to indicate any individual that is non-straight and/or non-cis (a cis person is someone whose gender assigned at birth corresponds to their gender identity). I believe in the power of reclaiming terms, therefore, in no way do I mean to use it as an offensive slur. I also use the word bisexual/bi+ to indicate people who are non-monosexual (e.g., pansexual, polysexual, etc.).
This article is primarily based on my research and practice as a therapist, as well as my experience as a queer woman and anorexia survivor. The theory and examples provided here are those I have observed and used in practice.
According to a recent survey published by the Trevor Project in 2018, 54% of the 1,034 young LGBTQ participants between the ages of 13 and 24 have been diagnosed with an eating disorder, with 75% having suspected that they had an eating disorder throughout their lifetime (The Trevor Project; National Eating Disorders Association; Reasons, 2018). Of those, 71% transgender responders who identify as straight have had a diagnosis of disordered eating. Bisexual LGBTQ youth reported the next highest rates of being diagnosed with an eating disorder – 51%. Overall, the most common diagnosis for all LGBTQ youth surveyed was anorexia nervosa.
These are troubling statistics – more so because it begs the same erroneous association some people make between being LGBTQ and being suicidal: that having a non-straight, non-cis identity somehow causes a person to develop mental disorders and attempt self-harm. However, studies have shown that it is not being queer that causes these disorders. Meyer’s Minority Stress Model (2003) emphasizes that stigma, prejudice, and discrimination create a stressful environment both on the outside (at work, at school, within the family, the community) and inside the person (low self-esteem, internalized homophobia, transphobia, acephobia (prejudice against asexual people), etc.). This environment is a breeding ground for mental health issues, among which eating disorders abound.
LGBTQ+ and Eating Disorders: What’s Different?
What’s different, indeed? As mentioned before, the most significant difference between being from a minority population and being from the majority, is that there is increased social pressure on the individual: whether it is the pressure to conform, stay in the closet, if you will; or whether it is the pressure to appear or act in a certain way.
On the surface. We are used to the idea of blaming eating disorders on the media and beauty standards. While these influences can play a role, they are not causal. There are often other factors maintaining an eating disorder – more complex than just being pretty by societal standards. However, self-image is an integral part of one’s identity, and for a lot of LGBTQ+ people, it is an integral part of who they are.
Let’s take, for example, the gay/bi male community. Gay men are classified into twinks, cubs, otters, bears; by the superficiality of dating apps like Grindr. The truth is that there are certain expectations as to what an MSM (a man who has sex with men) is supposed to look like: be fit or even skinny, with high muscle tone, and little fat. According to a 2016 study, gay men are more likely than heterosexual men to be dissatisfied with their physical appearance overall (29% versus 21%), as well as muscle size (45% versus 30%) (Frederick & Essayli, 2016). Muscle size plays a significant role when we talk about traditional masculinity: that a “real man” has to appear physically strong and cannot be “flabby,” for the lack of a better term. Fatphobia abounds in the queer male community, and the increased superficiality of one-night hookups and dating apps do not help, as most people on them are judged purely by appearance.
On the other hand, lesbian women appear to have better body image than straight women (Alvy, 2013). Why is that? Possibly because lesbian women are aware of the male-gaze fueled sexism in mainstream media. Therefore, it could be that gay women, in general, may be more accepting of the idea that human bodies are flawed, and that’s okay.
If that’s true, though, why is it then that over half of the bisexual and trans respondents to the Trevor Project suffer from eating disorders? We circle back to the idea of inherent acceptance.
Appearance and passing. The idea of “passing” took its roots in the history of the United States fueled by racism and colorism. The idea had to do with people of mixed race who were “white enough” to pass for being white and thus, would be treated “better” by the racist establishment at the time.
Nowadays, the term of passing is used by other communities, including the LGBTQ+ community as well. Some communities use the term in more positive connotations. In sexuality, there is almost always the assumption of heterosexuality – that straight is the default, which leads to LGBTQ+ people having to constantly engage in coming out, a process which can be quite painful and difficult when one doesn’t know whether they are heading into acceptance. However, passing as straight comes with a price – studies show that people who are out across various aspects of their lives (family, work, friends, etc.) have overall better mental health outcomes (Reynolds & Hanjorgis, 2000).
In gender, passing applies to being gendered accordingly to one’s true gender; this ties with the idea of stealth, passing as one’s true gender at all times and being surrounded by people who do not know about one’s transgender identity. Living in stealth or passing may be a blessing; however, they also contribute to erasing one’s identity as trans, which could be damaging to the person if they desire to keep their status as trans known.
On the other hand, there is the idea of misgendering, or referring to someone using words or pronouns that do not reflect their gender identity correctly: e.g., calling a trans woman a man. It’s quite obvious why that is detrimental to a transgender person’s identity – imagine being misnamed, misidentified, even ridiculed for not appearing “accurately” as one’s true identity (“you have boobs, you can’t be a guy”).
Thinness is often associated with maleness or androgyny. A person may be then more easily be seen as male or androgynous (nonbinary) if they appear thinner (mostly because one’s breasts and hips would also decrease in size). Some trans individuals who seek a more androgynous presentation may attempt to lose weight by dieting or over-exercising. That’s an example of the skin-deep level of beauty standards versus identity, wherein the individual takes control over their body in any way possible, thus causing themself harm.
For a bisexual/pansexual/polysexual (bi+) person, passing may be complicated as well. Despite the stereotype of bisexual people being promiscuous and/or polyamorous, most bi+ people exist within monogamous relationships. Thus, their sexuality, unless explicitly stated, is categorized into gay or straight according to the gender of their current partner. If I, a bisexual woman, were to date a man, I would be perceived as straight. If I were to date a woman, I would be seen as a lesbian. This is problematic for the same reason as living in stealth is, that the individual’s identity is erased and categorized into boxes that are more digestible to the mainstream.
Why is this bad? Well, imagine not being able to disclose part of yourself, being miscategorized or misgendered all the time. Being told that your identity hinges on that of your partner, or solely on what is between your legs.
These factors, among many others, including negative stereotyping about LGBTQ+ individuals, contribute to mental disorders, among which eating disorders are common. The harder part, of course, is the idea of internalized body dysmorphia (a distorted view of one’s body), gender dysphoria (the psychological distress a person experiences associated with the gender they were assigned at birth), and a general feeling of non-belonging, or queerness. Though not all trans people have gender dysphoria (American Psychiatric Association, 2013), in my experience, many trans people and other LGBTQ+ individuals report being uncomfortable, feeling out of place, feeling like they were somehow wrong or broken, and that their lives or minds were beyond their control.
Control: going deeper. Some theories of disordered eating state that eating disorders, and anorexia especially, have a lot to do with control. The activation of the pleasure centers in the brain that respond to the satisfaction of skipping a meal or restricting, for example, can be reinforced. Eating restrictively can become a source of comfort or pride, in the way that it is a testament to one’s strive for “perfection.” To someone who feels like they are wrong for this world, this dip into “perfection” and control may be a way to reconcile their identity, to try to find a way in which they too, can feel okay, even “normal” (I hate this term so much).
In the same way, control over one’s eating can be a form of self-punishment, in which a person consciously or not berates themself for not being “perfect,” for not meeting the expectations of society. Though it is quite blunt to put it in these terms, but a lot of the time, eating disorders boil down to the idea of being unlovable, being bad: I am queer –> I disappointed the people I love by being queer –> I’m bad –> I deserve to be punished –> I don’t deserve food. It’s a double-edged sword of working towards perfection and approval (or, at least, being more “digestible” ) and making oneself suffer. In a perverted way, eating disorders may also a way to correct the queer narrative, to be more “perfect.”
Similarly, disorders that have to do with bingeing and overeating in general may have certain emotionally mollifying effects: filling the void that one’s imperfection leaves with food, or, as experience has shown in therapy, purposefully punishing oneself by making themself as “ugly” as they feel on the inside (of course, laboring under the assumption that additional weight is associated with physical deformity).
How Do We Make It Better?
We see how these ideas circle back to stigma, to societal pressure, and to the way we think about ourselves. It’s easy to say that to prevent eating disorders in LGBTQ+ people: we should just have a more equal, more accepting society. Though a lot of work has been done in that direction, many countries in the world refuse to accept LGBTQ+ individuals; what is worse, the community itself is unfortunately filled with separation and prejudice (biphobia, transphobia, acephobia, racism, classism, etc.).
Education, of course, is an essential part of prevention: both education for the straight/cis majority, and also education for LGBTQ+ people, starting in childhood. If a person grows up in a society wherein difference is normalized, they feel less pressure to conform to a standard and are thus less prone to developing unhealthy responses. It is also vital to educate mental and physical healthcare professionals to work with LGBTQ+ populations and to be able to work with complex identities in general.
Policy is another crucial factor. Those in power should use their power for the better – therefore, working on accepting the LGBTQ+ community, building centers, creating environments in which minorities have access to physical and mental health care, all these things are essential; and as voters and as people, we have the ability to influence the decisions of the people we voted into office.
Treatments. On a more personal level, people who have gone to therapy for eating disorders, in general, fare better than those who don’t seek treatment (Hubbard, 2013). There are many models of treatment for eating disorders: from the simplest CBT and schema therapy (working on the basic idea of being unlovable) to more complex acceptance and commitment therapy, narrative therapy, and the like. There are mindfulness-based programs designed to make one more aware of their body and accept it the way it is, to lessen the iron-clad control they might exercise over their eating habits. There are in-patient and out-patient programs, group therapies, meetings, etc.
However, when we look at the idea of diversity in mental health, a lot of the times, we come face-to-face with the fact that we only look at one thing: that a person is either queer, or a person of color, or depressed, or anxious, or something else; which means, we don’t look at the whole person, we nitpick and treat things that we are more comfortable with. It is true that therapy was designed by affluent, straight, white men. However, it doesn’t have to be this way.
I encourage mental health professionals to step outside your comfort zone – to learn about other identities and be able to integrate them into your work. Ask questions, be critical of yourself and the world, and remember that your queer may be different to my queer.
And for the LGBTQ+ youth out there, I want to advise you to seek help from people who make you feel welcome and understood. The world may be difficult to deal with sometimes, but that doesn’t mean that you should sacrifice who you are for the sake of integrating. Be yourself, be kind, and remember that asking for help is not a sign of weakness, it’s a sign of trust.
About The Author:
Mariya Shcherbinina is a counseling psychotherapist based in The Hague, the Netherlands. She runs BiPositive, a podcast surrounding the experience of bisexual and queer-identifying people, as well as TheBadFoodie, a blog on the experience of and recovery from anorexia nervosa.
Written – 2018