Treating eating disorders in the LGBTQIA+ adult population: A scoping review

Figures & data

Table 1. Keyword search terms.

Key concept	Search in	Keyword search terms
Eating disorder	Title, keywords, abstract, and text	eating disorder
LGBTQIA+ population	Title, keywords, abstract, and text	lgbt OR lgbtqia+ OR gay OR lesbian OR bisexual OR transgender OR queer OR sexual minorities OR gender minorities
Treatment	Title, keywords, abstract, and text	treatment OR care OR therapy

LGBTQIA+, lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender.

Figure 1. Flowchart of study selection.

Table 2. Main characteristics of the included articles.

Reference	Country	Study design	LGBTQIA+ population	Sample size	Age (years)	Treatment	Main findings
Theme 1: Conventional treatments applied to the LGBTQIA+ population
Treatment outcomes
Donahue et al., 2020	USA	Case-control study	SM	389 (of whom 79 were SM)	Mean age = 21	Conventional treatment (DH)	SM patients experienced improvement at a faster rate compared to heterosexual patients
Murray et al., 2021	USA	Case-control study	SM women	2502 (of whom 134 were lesbian and 270 were bisexual)	Mean age = 27	Conventional treatment	Despite differences at admission on preoccupation, restriction, fasting, vomiting, shape, and weight concerns, women across groups experienced similar treatment outcomes
Riddle et al., 2022	USA	Case-control study	TG or NB	401 (of whom 25 were TG/NB)	Mean age = 26	Conventional treatment (HLOC)	TG or NB individuals experienced improvement in ED symptoms but less so in depression and suicidality
Self-reported treatment appraisal
Duffy et al., 2016	USA	Observational study	TG	84	Mean age = 22	Conventional treatment	Participants reported deficits in clinicians’ gender competence, resulting in the belief that ED treatment was ineffective and sometimes harmful
Hartman-Munick et al., 2021	USA	Observational study	TG, NB, or another gender different from the assigned at birth	66	Age range = 18–30	Conventional treatment	Respondents discussed the presence of barriers to ED screening/treatment, the complexity of the relationship between ED and gender dysphoria, and the need to educate providers in gender-responsive care practices for ED screening and treatment
Joy et al., 2022	Canada	Observational study	Gender diverse	10	Age range = 21–38	Conventional treatment	Several barriers hinder access to ED treatment, most notably, cisnormative biases and inability to validate the gender-diverse individual’s experience of eating symptoms
Theme 2: Specific treatments for the LGBTQIA+ population
Interventions addressed to the LGBTQIA+ population
Brown & Keel, 2015	USA	Randomized trial	Gay males	87	Age range = 18–30	Cognitive dissonance–based intervention	Decreasing in BID, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms
Medical gender transition and its secondary effect on ED symptoms
Hepp & Milos, 2002	Switzerland	Case reports	TG AMAB and AFAB	3	22, 35, and 43	Gender transition (hormonal treatment, SRS)	The preoccupation with body weight and shape did not decrease
Winston et al., 2004	UK	Case reports	AMAB	2	46 and 41	Conventional treatment and gender transition (HLOC, IP, GAS)	The impact of IP can be different in different participants; GAS reduces BID
Ewan et al., 2014	USA	Case report	TG AMAB	1	19	Gender transition (E and/or GnRH agonist)	Addressing GAH along with ED treatment can facilitate medical stabilization and weight restoration
Turan et al., 2015	Turkey	Case report	TG AFAB	1	41	Gender transition (T, SRS)	GAH and GAS result in substantial improvement in the ED
Hiraide et al., 2017	Japan	Case reports	TG AMAB and AFAB	2	35	Gender transition (GAS, E, T)	GAS can reduce BID and improve ED symptoms
Jones et al., 2018	UK	Cross-sectional study	TG AMAB and AFAB	563	Mean age = 29	Gender transition (CHT)	GAH can alleviate ED symptoms by impacting BID, perfectionism, and anxiety and self-esteem
Nowaskie et al., 2021	USA	Cross-sectional study	TG AMAB and AFAB	166	Mean age = 31	Gender transition (GAH, GAS)	GAH and GAS alleviate ED symptomatology; the beneficial effect of GAS is clearer than GAH

AMAB, assigned male at birth; AFAB, assigned female at birth; BID, body image dissatisfaction; CHT, cross-sex hormone therapy; DH, day hospital; E, estrogen; ED, eating disorder; GAH, gender-affirming hormones; GAS, gender-affirming surgeries; GnRH agonist, gonadotropin-releasing hormone agonist; HLOC, higher levels of care; IP, individual psychotherapy; LGBTQIA+, lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender; NB, nonbinary; SM, sexual minorities; SRS, sex reassignment surgery; T, testosterone; TG, transgender.

Figure 2. Macro-themes and respective sub-themes.

Donahue, J. M., DeBenedetto, A. M., Wierenga, C. E., Kaye, W. H., & Brown, T. A. (2020). Examining day hospital treatment outcomes for sexual minority patients with eating disorders. The International Journal of Eating Disorders, 53(10), 1657–1666. https://doi.org/10.1002/eat.23362

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Murray, M. F., Cox, S. A., Henretty, J. R., & Haedt-Matt, A. A. (2021). Women of diverse sexual identities admit to eating disorder treatment with differential symptom severity but achieve similar clinical outcomes. The International Journal of Eating Disorders, 54(9), 1652–1662. https://doi.org/10.1002/eat.23576

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Riddle, M. C., Robertson, L., Blalock, D. V., Duffy, A., Le Grange, D., Mehler, P. S., Rienecke, R. D., & Joiner, T. (2022). Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals. International Journal of Eating Disorders, 55(11), 1532–1540. https://doi.org/10.1002/eat.23812

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Duffy, M. E., Henkel, K. E., & Earnshaw, V. A. (2016). Transgender clients’ experiences of eating disorder treatment. Journal of LGBT Issues in Counseling, 10(3), 136–149. https://doi.org/10.1080/15538605.2016.1177806

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Hartman-Munick, S. M., Silverstein, S., Guss, C. E., Lopez, E., Calzo, J. P., & Gordon, A. R. (2021). Eating disorder screening and treatment experiences in transgender and gender diverse young adults. Eating Behaviors, 41, 101517. https://doi.org/10.1016/j.eatbeh.2021.101517

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Joy, P., White, M., & Jones, S. (2022). Exploring the influence of gender dysphoria in eating disorders among gender diverse individuals. Nutrition & Dietetics, 79(3), 390–399. https://doi.org/10.1111/1747-0080.12727

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Brown, T. A., & Keel, P. K. (2015). A randomized controlled trial of a peer co-led dissonance-based eating disorder prevention program for gay men. Behaviour Research and Therapy, 74, 1–10. https://doi.org/10.1016/j.brat.2015.08.008

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Hepp, U., & Milos, G. (2002). Gender identity disorder and eating disorders. The International Journal of Eating Disorders, 32(4), 473–478. https://doi.org/10.1002/eat.10090

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Winston, A. P., Acharya, S., Chaudhuri, S., & Fellowes, L. (2004). Anorexia nervosa and gender identity disorder in biologic males: A report of two cases. International Journal of Eating Disorders, 36(1), 109–113. https://doi.org/10.1002/eat.20013

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Ewan, L. A., Middleman, A. B., & Feldmann, J. (2014). Treatment of anorexia nervosa in the context of transsexuality: A case report. The International Journal of Eating Disorders, 47(1), 112–115. https://doi.org/10.1002/eat.22209

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Turan, Ş., Poyraz, C. A., & Duran, A. (2015). Prolonged anorexia nervosa associated with female-to-male gender dysphoria: A case report. Eating Behaviors, 18, 54–56. https://doi.org/10.1016/j.eatbeh.2015.03.012

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Hiraide, M., Harashima, S., Yoneda, R., Otani, M., Kayano, M., & Yoshiuchi, K. (2017). Longitudinal course of eating disorders after transsexual treatment: A report of two cases. BioPsychoSocial Medicine, 11(1), 32. https://doi.org/10.1186/s13030-017-0118-4

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Jones, B. A., Haycraft, E., Bouman, W. P., Brewin, N., Claes, L., & Arcelus, J. (2018). Risk factors for eating disorder psychopathology within the treatment seeking transgender population: The role of cross-sex hormone treatment. European Eating Disorders Review, 26(2), 120–128. https://doi.org/10.1002/erv.2576

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Nowaskie, D. Z., Filipowicz, A. T., Choi, Y., & Fogel, J. M. (2021). Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation. International Journal of Eating Disorders, 54(8), 1493–1499. https://doi.org/10.1002/eat.23539

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Data availability statement

Not applicable.