Examining day hospital treatment outcomes for sexual minority patients with eating disorders

Abstract

Objective: Epidemiological data support that sexual minorities (SM) report higher levels of eating pathology. Theories suggest these disparities exist due to stressors specific to belonging to a minority group; however, few studies have specifically explored differences between SM and heterosexual individuals in clinical eating disorder samples. Thus, the present study compared SM and heterosexual patients with eating disorders on demographic characteristics and eating disorder and psychological outcomes during day hospital treatment. Method: Patients (N = 389) completed surveys of eating pathology, mood, anxiety, and skills use at treatment admission, 1-month post-admission, discharge, and 6-month follow-up. Overall, 19.8% of patients (n = 79) identified as SM, while 8.0% (n = 32) reported not identifying with any sexual orientation. SM were more likely to present across genders (17.7% of females, 24.2% of males, 33.3% of transgender patients, and 87.5% of nonbinary patients). Results: SM patients were significantly more likely to endorse major depressive disorder, panic disorder, and self-harm at admission than their heterosexual counterparts. Multilevel models demonstrated that across time, SM patients demonstrated greater eating pathology, emotion dysregulation, depressive symptoms, and anxiety symptoms. Significant interactions between sexual orientation and time were found for eating pathology and emotion dysregulation, such that although SM patients started treatment with higher scores, they improved at a faster rate compared to heterosexual patients. Discussion: Consistent with minority stress theory, SM patients report greater overall eating disorder and comorbid symptoms. Importantly, results do not support that there appear to be significant disparities in treatment outcome for SM patients in this sample of day hospital patients.

Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals

“…Thus, it is also possible that, as our data suggest, ED severity is similar across gender modalities at the time of presentation to a higher level of care. There were significant improvements in ED symptoms by time of discharge for TNB patients that was comparable to that of their cisgender peers, which aligns with previous studies that included TNB individuals but were underpowered to report on them as a distinct cohort (Coelho et al, 2021; Donahue et al, 2020). Previous qualitative research has raised concerns that standard ED treatment may be ineffective for TNB individuals (Duffy et al, 2016).…”

Comparing eating disorder treatment outcomes of transgender and gender diverse adolescents with those of cisgender adolescents

“…Both TGD and cisgender adolescents showed significant improvement in ED symptoms over the course of their time in treatment, as measured by a decrease in EDE-Q scores. This is similar to previous studies that included TGD individuals descriptively but were underpowered to include them as a distinct group in their analysis, as well as a study in adults that showed similar improvement between the TGD and cisgender cohorts (Coelho et al, 2021;Donahue et al, 2020;Riddle et al, 2022). While similar improvement across gender modalities is reassuring and would suggest TGD individuals can benefit from HLOC ED treatment, it is critical that the field con- As seen in other studies, we found increased levels of depression and suicidality in TGD youth compared to their cisgender peers, and this highlights the need for targeted interventions (Becerra-Culqui et al, 2018;Mak et al, 2020).…”

Women of diverse sexual identities admit to eating disorder treatment with differential symptom severity but achieve similar clinical outcomes

“…In an independent study using a different subset of the dataset analyzed in this study, Mensinger et al (2020) found that sexual and gender minority patients admitted to higher levels of care with greater global ED severity but had little to no differences in outcomes compared to cisgender heterosexual patients. Donahue et al (2020) found similar results among SM patients in a partial hospitalization program and, interestingly, both studies found that despite greater initial global ED severity, SM patients improved sooner in treatment than heterosexual patients. Results of both studies, however, are limited by their use of collapsed SM groups, as there may be potential notable differences in ED symptomatology among SM subgroups.…”