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Eating disorders can affect anyone at any stage in life, but most develop in teens and young adults. A population that is at risk for developing eating disorders is the LGBTQ+ community.

Developing Eating Disorders

Eating disorders include binge eating disorder, anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder. Eating disorders can develop from multiple factors including stress, family history, or a related mental health issue, like low self-esteem or a lack of healthy coping strategies.

According to the National Eating Disorder Association, the LGBTQ+ community is at high risk of developing an eating disorder due to:

• Feelings of or worries about rejection.
• Negative talk about sexual orientation, gender expression, and transgender status.
• Violence in their lives and PTSD from traumatic events.
• Being bullied or facing bias.
• Lack of harmony between one’s biological sex and gender identity.
• Body image expectations within some LGBTQ+ communities.

A specific focus at UPMC is on providing gender-affirming care in all areas, including in the treatment of eating disorders in gender-diverse people.

Signs of Eating Disorders

Eating disorders can take control of a person and can lead to significant health concerns.  Out of all mental health diagnoses, eating disorders has one of the highest mortality rates. Trying to beat it on one’s own can be isolating and defeating. If you want to help someone on this journey, the first step is to see the signs.

Anorexia nervosa

People with anorexia nervosa tend to be significantly low weight, fear gaining weight, and have body image issues. They also tend to deny that they have health issues caused by their low weight.

Bulimia nervosa

People with bulimia nervosa have a habit of binge-eating. They also use vomiting, laxatives, diet pills, fasting, or excessive exercise to control weight. They link their self-esteem to their weight or shape.

Binge-eating disorder

People with binge-eating disorder habitually binge eat at least once a week for at least three months. Binge-eating can include three or more of the following:

• Eating much faster than normal.
• Eating until uncomfortably full.
• Eating large amounts of food when not feeling hungry.
• Eating alone because of embarrassment about overeating.
• Feeling disgusted, depressed, or very guilty after overeating.

Avoidant restrictive food intake disorder (ARFID)

Individuals with ARFID show a lack of interest in eating, avoid foods based on sensory aspects of those foods, or do not eat due to concern about negative consequences of eating such as choking or vomiting.  Other signs include:

• Significant weight loss
• Severe nutritional deficits
• Dependence on nutritional supplements

Addressing a Loved One’s Eating Disorder

When your LGBTQ+ loved one is showing signs of disordered eating, they may need your aid in getting help. Often these disorders cloud a person’s ability to understand the seriousness of the situation. Remember to show empathy and care throughout the whole process.

Education is key. Gain as much knowledge as possible and talk to your loved one about different eating disorders and their symptoms. These talks can get heated, so your knowledge will help you stick to the facts.

Be prepared. Prepare the points you want to get across and talk to your loved one in a private and pleasant place. Having materials and resources to point them to for help is also vital. Speak in ways that affirm their gender or sexual identity.

No shame. The goal is to help your loved one to get help. Telling your loved one about the stigma around eating disorders or what others may think of them will not be helpful.

Leave the conversation open. It can take a lot of time and work to deal with an eating disorder. Letting them know you are there to support them when they are ready to seek help can make a big impact.

It’s important to remember that one size treatment doesn’t fit all. Specific concerns of gender-diverse people with eating disorders can include:

• Body dysphoria, or not liking your body.
• The effects of gender-affirming hormones on eating.
• Having an eating disorder specialist who is gender-affirming and trained in understanding body dysphoria.

Eating Disorder Resources

UPMC Children’s Hospital of Pittsburgh has a brief medical stabilization and refeeding program for children needing medical care for their eating disorders.

Call UPMC Children’s Behavioral Health with questions about this program at 412-692-5100.

The UPMC Center for Eating Disorders provides comprehensive eating disorder evaluation and treatment for both children and adults. It is one of the nation’s few eating disorder treatment programs affiliated with a major academic medical center.

For more information or to schedule an appointment, contact the UPMC Center for Eating Disorders at 412-246-6390.

Learn more about how we treat eating disorders.

Editor's Note: This article was originally published on January 31, 2023, and was last reviewed on June 19, 2024.