Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment

Abstract

Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care. Objective: To (a) compare history of abuse‐related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs. Method: We analyzed data from 2,818 individuals treated at a large, US‐based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed‐effects models. Results: SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE‐Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE‐Q scores did not differ between SGMs and CHs. Discussion: Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs—possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.