How Current Eating Disorder Discourse Fails The LGBTQ Community. And How We Can Change That.

Treatment needs to be a gender diverse and an inclusive environment.
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Eating disorder recovery is unique in that there is still little consensus for what it means to be “recovered.” For those of us seeking recovery this can often feel unimaginable, ambivalent, and open-ended, as we’re fighting to achieve a state of being that seems elusive and unknown.

Despite this, there has still been the construction of a mainstream eating disorder discourse which due to its limited nature reinforces stereotypes of the experiences of people suffering from an eating disorder. As a result, this mainstream dialogue is dangerously failing marginalized communities, including the LGBTQ community.

Four Ways Discussions of Eating Disorder Recovery Fail the LGBTQ Community

1. Dominant eating disorder discourse has focused primarily on the experiences of white, middle to upper class, able-bodied, cis-gender, heterosexual women, thereby perpetuating a particular standard of femininity within a rigid heteronormative framework. Appealing to the ‘opposite sex’ is seen as desirable and as the only possibility. In other words, heterosexuality becomes the only acceptable sexual orientation, thus ignoring the values and voices of the LGBTQ community

During one of the more didactic, skills-based groups I attended during residential treatment, I distinctly remember the moment, perhaps after the third or fourth time I was asked to think about my “boyfriend”, when I no longer felt like there was space for me to share in the group. The therapist’s discourse implied the assumption that we were all either in a relationship with the opposite sex or were hoping recovery would provide us with that generous “gift”. Physically, I felt small and emotionally I felt unimportant and invalidated. At the end of the group, I asked the therapist if she could use more inclusive language such as “partner” or “significant other”. She responded with a curt “yes” and her facial expression portrayed disbelief and misunderstanding.

The following week, I felt silence when I walked into the same group and was again asked to think about my “boyfriend” in a hypothetical recovery-oriented situation. Experiences like this have made me view my body image issues as illegitimate.

2. Mainstream eating disorder dialogue dictates that women not only need to inhabit “womanly” shaped bodies, but they also need to enjoy and accept their bodies. With the rise in use of eating disorder recovery hashtags such as #bodyacceptance and #bodypositivity, there is increasing pressure to conform to the heteronormative, cis-gender images that are generally depicted. There is nothing wrong with this portrayal, other than the fact that it is limiting in the representation of the people who experience eating disorders and in the expectations of recovery itself.

For those of us who present and identify outside of the gender binary, our bodies do not necessarily align with the narrowly subscribed expectations of the body, as evidenced by a quick search of the hashtags #eatingdisorderrecovery and #edrecovery. As it stands now, there is limited space for our experience to be viewed as legitimately suffering from an eating disorder, resulting in decreased self-worth, body acceptance, and increased feelings of invalidation.

Achieving body acceptance for almost anyone with an eating disorder is incredibly difficult. To help encourage those struggling, treatment standards provide hope that body image issues will resolve themselves as you persist through recovery. For non-cisgendered people though, this line of thinking fails to attend to our lived experiences, as body changes in recovery are often further complicated if appearance makes us feel more disconnected from the internal experiences of ourselves.

In other words, body acceptance doesn’t work with gender dysphoria. By definition, acceptance is about immersion. It is absurd to be told in treatment to accept my body within the context of the very culture that has traumatized and refused to acknowledge my body and identity as legitimate. Not only do we need to learn to accept our bodies outside of the eating disorder, but we also need to confront and challenge the discomfort of incongruence with physical appearance and gender expression/identity, along with the isolation associated with feeling outside the “norm”. Gender dysphoria compounds the issue of body acceptance by necessitating the need to value and respect the bodies in which we exist.

As a result, my eating disorder became focused on the desire to be “smaller” and to take up less space. Food became a way to control the body through amenorrhea and by losing secondary sexual characteristics including breasts and curves. The drive for “thinness” is a drive towards the elimination of one’s gender and/or desexualization on one hand, and the desire to emphasize features of being non-binary on the other hand.

3. Research on the LGBTQ community and eating disorders is sparse, inadequate, and the statistics that do exist, lack representation of important identities. Research continues to support beliefs that queer women who identify as less feminine, deemphasize their physical appearance, and therefore have less of a risk for developing eating disorders than people who identify as heterosexual and/or feminine (Ludwig & Brownell, 1999). Research has also proposed that queer women are immune to eating disorders because they do not share the desires of the standards of feminine beauty espoused by heterosexual women (Feldman & Meyer, 2007).

Such assumptions are reductive and invalidating, and reflect a misunderstanding of the causes and consequences of eating disorders (a strong genetic component plus any number of environmental risk factors). Research also generalizes the experiences of those in the LGBTQ community who have eating disorders and does not recognize the unique nature of eating disorders even among members of the LGBTQ community.

4. Mainstream eating disorder pedagogy ignores the potential impact that discrimination and violence have on the development and prevalence of eating disorders in the LGBTQ community. Discrimination, violence, and oppression lead to increased isolation and decreased self-worth, which makes it difficult to seek help.

This is an act of violence.

The desire to be invisible is related to the shame that results from trauma caused by growing up in a homophobic, heteronormative society. We aren’t born with protection against self-hatred and it’s important to confront the fact that there’s trauma associated with feeling different and unworthy.

The consequences of oppression and micro-aggression are real, including but not limited to, the fear of not being taken seriously, and the hesitation to subvert cultural norms that prevent seeking treatment. These barriers have the potential to have lasting and devastating effects on queer people’s body image, self-acceptance, and feelings of shame.

How Can Eating Disorder Treatment Become More LGBTQ-Affirming?

1. Treatment needs to be a gender diverse and an inclusive environment, instead of focusing on treating the binary. This includes incorporating education on the use of inclusive language to therapists facilitating groups, and includes using inclusive language on intake forms. All identities and genders need to be viewed as acceptable, with no one standard or norm. Providers need to recognize the differences and be critical of their own roles and biases in the oppression of LGBTQ patients.

2. The LGBTQ community needs safe and affirming spaces to discuss body image issues that are specific to us. For instance, I want to feel profoundly connected to a group of people that want to talk about wearing men’s underwear! I want to talk about how to find clothes that simultaneously align with my gender expression and my body image issues related to my eating disorder. The way treatment, as I’ve experienced, is constructed is that there are prescribed topics deemed “acceptable”, however these limited topics exist within a heteronormative, rigid systemic structure and do not tend to acknowledge gender identity and sexual orientation.

3. It is essential to recognize how eating disorders affect members of the LGBTQ community, and evaluate how they can better include and represent marginalized voices within that dialogue. We need to make visible and heal the compounding experiences and unique stressors of the LGBTQ community with sensitivity.

4. Everyone deserves to feel affirmed and empowered in treatment, and that’s why implementing specialized treatment tracks that can address nuances and risk factors relevant to the LGBTQ community is so important.

If you’re struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.