Eating Disorders in the LGBTQIA+ Community: Affirming, Evidence-Based Therapy in NYC and Massachusetts

LGBTQIA+ individuals experience higher rates of eating disorders due to trauma, dysphoria, and body image distress. Learn how inclusive, evidence-based therapy (including CBT-E) can support recovery in NYC and Massachusetts.

Understanding the Link Between Eating Disorders and LGBTQIA+ Identity

Eating disorders are complex psychiatric conditions that impact individuals of all backgrounds—but research consistently shows that members of the LGBTQIA+ community are at a significantly elevated risk. These disorders often develop and persist not only due to internal factors (like perfectionism or anxiety), but also from external pressures—such as discrimination, marginalization, trauma, and body-based stigma.

Members of the LGBTQIA+ community experience substantially higher rates of eating disorders and disordered eating behaviors compared to their heterosexual and cisgender peers. For instance, while gay men represent roughly 5% of the male population, they account for 42% of men with eating disorders and are significantly more likely to engage in behaviors such as fasting, purging, or using diet pills — sometimes at rates up to twelve times higher than straight men . Transgender and gender-expansive individuals also face disproportionately elevated risks, with nearly one-in-four recently engaging in dietary restriction or binge eating behaviors. These disparities are rooted in factors like gender dysphoria, internalized stigma, and societal pressure around body image—compounded by healthcare barriers and discrimination within medical settings. This research underscores the importance of offering affirming, culturally competent care specifically tailored to LGBTQIA+ individuals struggling with eating-related distress.

1. Body Image Pressure in Gay and Bisexual Men

Gay and bisexual men often face intense body image expectations within their communities. While they make up a small percentage of the general population, they account for a disproportionately large share of men with eating disorders. Many report that pressure to achieve a lean or muscular physique—paired with messaging around desirability—contributes to unhealthy eating behaviors, excessive exercise, and body dissatisfaction.

2. Eating Disorders and Gender Dysphoria

For many transgender and nonbinary individuals, eating disorder behaviors may be tied directly to managing gender dysphoria. Restricting food intake, for example, may be used as a way to suppress gendered features such as menstruation or muscle development. Bingeing or purging may also be used to cope with the distress of not feeling at home in one's body. These behaviors aren’t always about thinness, but rather a deeply personal effort to align one’s body with their gender identity.

3. Minority Stress and Internalized Shame

LGBTQIA+ individuals often navigate layers of societal stigma, discrimination, and internalized shame—experiences that can increase vulnerability to mental health struggles, including eating disorders. For some, food becomes a means of control, a way to numb emotional pain, or a form of self-punishment tied to feeling different or “not enough.” These patterns are often overlooked when providers assume eating disorders stem solely from appearance-related concerns.

4. Different Presentation Across LGBTQIA+ Subgroups

Eating disorders don’t show up the same way across the LGBTQIA+ spectrum. Research suggests that bisexual individuals may experience especially high rates of disordered eating, while lesbian individuals show mixed patterns depending on their exposure to body image norms. Nonbinary people may restrict or binge in relation to gender stress rather than body size. Each subgroup has distinct needs, and a one-size-fits-all approach to treatment often misses the mark.

5. Lived Experiences Illustrate the Complexity

Personal stories shed light on how deeply identity and disordered eating can intersect. One trans man described restricting food not to lose weight, but to “feel less feminine” during puberty. A gay man shared how years of internalized homophobia and shame led him to overexercise and restrict as a way of earning worthiness in queer spaces. A nonbinary youth explained that their binge-restrict cycle wasn’t about dieting—it was about trying to disappear when they didn’t feel safe in their own skin. These aren’t isolated stories—they reflect broader patterns in the LGBTQIA+ experience that deserve nuanced, affirming care.

Evidence-Based Treatment with an Affirming Lens

As a therapist specializing in eating disorders, I combine evidence-based interventions with a deeply affirming, trauma-informed approach tailored to LGBTQIA+ clients. One primary modality I use is CBT-E (Enhanced Cognitive Behavioral Therapy),a transdiagnostic treatment model that addresses the cognitive, emotional, and behavioral factors that maintain all forms of eating disorders.

CBT-E focuses on:

• Identifying and disrupting maintaining mechanisms (e.g., dietary restraint, overvaluation of weight and shape, body checking).

• Normalizing eating patterns and restoring nutritional stability.

• Addressing co-occurring concerns such as perfectionism, low self-esteem, and interpersonal difficulties.

• Preventing relapse through personalized coping strategies and long-term planning.

Importantly, CBT-E is adaptable to the unique needs of LGBTQIA+ individuals. When combined with a queer- and trans-affirming framework, it becomes a powerful tool not only for behavioral change, but also for supporting identity development, self-worth, and body safety.

Therapy That Sees the Whole You

Recovery from an eating disorder is not just about stopping behaviors—it’s about healing relationships with your body, your identity, and your inner world. I work with LGBTQIA+ adults and teens across New York City and Massachusetts, offering virtual therapy designed to be safe, affirming, and clinically effective.

Whether you’re navigating restriction, binge eating, purging, body image distress, or the impact of gender dysphoria on food and self-perception…you’re welcome here.

References

• ACUTE Center for Eating Disorders. (2023). Eating Disorders in the LGBTQ+ Community: Prevalence & Disparities. https://www.acute.org/resources/eating-disorders-lgbtq-community

• YoungMinds. (2023). My Experience of an Eating Disorder as a Trans Man. https://www.youngminds.org.uk/young-person/blog/my-experience-of-an-eating-disorder-as-a-trans-man

• The Trevor Project. (2022). Research Brief: Eating Disorders Among LGBTQ Youth. https://www.thetrevorproject.org/research-briefs/eating-disorders-among-lgbtq-youth-feb-2022

• Parker, L. L., & Harriger, J. A. (2020). Eating disorders and disordered eating behaviors in LGBT populations: A review of the literature. Journal of Eating Disorders. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00327-y

• Teen Vogue. (2020). Mina Gerges on Body Image and Queer Representation. https://www.teenvogue.com/story/mina-gerges-fashion-plus-size-men

• them. (2020). Man Made: Queer Men and Eating Disorders. https://www.them.us/story/man-made-eating-disorders