Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Gender Non-conforming Adults: Comparative Levels and a Proposed Mediational Model

Abstract

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.

Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations

“…Similarly, transgender women previously reported higher scores on the Shape Concern subscale than presumed cisgender women [20]. Shape concerns in genderexpansive individuals may be linked to gender dysphoria and body dissatisfaction when one's body shape is discrepant from one's gender identity [18,37,38]. It may be especially challenging for gender-expansive individuals to attain certain shape ideals when certain anatomic structures cannot be altered medically or surgically [38,39].…”

“…Johnson et al [17] have described invalidation ("the refusal to accept someone's identity as 'real' or 'true'") as a unique form of minority stress that impacts genderexpansive individuals and is a contributing factor to significant psychological distress. Bell et al [18] found that perceived stigma was indirectly associated with eating disorder proneness that was mediated by self-compassion among transgender and gender-nonconforming adults.…”

How do people with eating disorders experience the stigma associated with their condition? A mixed-methods systematic review

“…Transgender individuals are also at higher risk of EDs due to general body dissatisfaction and desire to affirm gender through body shape (Jones et al, 2018;Testa, Rider, Haug, & Balsam, 2017). Underlining the intersectionality of stigma processes, the persistent sexual stigma experienced by LGBT communities can amplify ED proneness (Bell, Rieger, & Hirsch, 2019). However, no studies in this review investigated how the experience of ED stigma interacted with LGBT identities.…”

Theoretical and Methodological Considerations for Research on Eating Disorders and Gender

“…Researchers of ED in sexual and gender minorities stress the relevance of stigmatization and its psychological consequences ( Bell et al, 2019 ). Scholars have established the fact that minority stress leads to psychological strain ( Meyer, 2003 ), but in terms of ED, it is important to understand how minority stress influences a person’s relationship with their body ( Bosley, 2011 ).…”

“…As Testa et al (2017) demonstrated, the effect of gender confirming interventions on body satisfaction is mediated by reduced non-affirmating social experiences (e.g., being referred to with incorrect pronouns). Various studies have highlighted the general importance of social acceptance versus discrimination for ED pathology in transgender and non-binary persons ( Watson et al, 2017 ; Bell et al, 2019 ). Goldhammer et al (2019) have outlined ways to address minority stress issues in interventions.…”