In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.

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The adolescent with disordered eating symptoms, who may still be a minor, presents a special case with respect to diagnosis and treatment. The symptoms and severity of anorexia nervosa (AN) are such that involuntary treatment might be required to preserve life. Although the peer-reviewed literature generally accepts that AN is a serious biologically based disorder (Klump, Bulik, Kaye, Treasure, & Tyson, 2009), there is a proanorexia argument that eating disorders are a lifestyle choice (Fox, Ward, & O'Rourke, 2005; Overbeke, 2008). The ethical decision-making process outlined in the Companion Manual to the Canadian Code of Ethics for Psychologists (Sinclair & Pettifor, 2001) is useful for a psychologist to substantiate lower thresholds for involuntary treatment for adolescents with AN.

The Canberra Eating Disorders Program (EDP) is a specialised program which treats people with an eating disorder of any age. The EDP uses Family Based Therapy (FBT) to treat both younger and older adolescents with an eating disorder. FBT is the most effective treatment for adolescents with Anorexia Nervosa; however, the evidence supporting the use of FBT in the older adolescent and young adult group is mixed. There is also limited data around the experience of implementing FBT in treatment settings for the older adolescent age group. Anecdotal evidence suggests that treating older adolescents presents different challenges to treating younger adolescents and impacts clinical outcomes. Throughout treatment EDP has seen strengths using FBT in older adolescents including levels of engagement, recovery rates, and family involvement. However, there are also difficulties, such as acceptance of FBT as the treatment, and concerns around interrupting young adult development. Clinical outcomes at the EDP for the 16 to 19 year old age group suggests that FBT has a higher remission rate than individual therapy or day program, and leads to greater treatment adherence. However, in this older age group modification to the model is often required to improve treatment success.This abstract was presented in the Children and Youth Treatment and Service Development stream of the 2013 ANZAED Conference.

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