Lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents and young adults experience elevated risk for eating disorders. Dissonance-based body image interventions have been successful in addressing eating disorders symptoms by decreasing susceptibility to societal appearance ideals and resulting body dissatisfaction. However, interventions have not been adapted for diverse LGBTQ populations. To inform the development of a tailored body image intervention, we explored how societal appearance ideals are perceived by and influence eating disorders risk factors among LGBTQ college students.
This formative study comprised a quantitative survey (n=58) and six focus groups (n=30) with LGBTQ students recruited via flyers, events, and listserves at two urban New England universities (one private, one public). Participants were undergraduate students (mean age 19.7 years). The sample was 74% cisgender (i.e., non-transgender) female, 15% cisgender male, 3% transmasculine, 5% non-binary, 3% another gender identity; 37% identified as people of color. Guided by minority stress theory and a sociocultural model of eating disorders risk, survey and focus group topics included identities, appearance ideals, experiences of discrimination, and disordered eating behaviors. Focus group recordings were transcribed, double-coded, and analyzed using a deductive thematic analysis approach.
The majority of survey participants (80.4%) reported experiencing at least one form of discrimination in the past year, and 60.9% reported at least one disordered eating behavior. In focus groups, participants identified traditional media, social media, LGBTQ-specific media, dating apps, and family as sources of appearance ideals. Four key focus group themes emerged. (1) Appearance ideals interact with sexual and gender identity development (e.g., “Even [if] they’re questioning if they’re gay or not… now they’re seeing all these pictures [on social media]. And it’s like, ‘Okay, I can either be very muscular or very thin, because that’s the right way to do it!’”). (2) Appearance ideals are inextricable from LGBTQ stereotypes (“There’s the expectation that [bisexual women] want everyone, or you want to have threesomes. But no matter what their expectation of me is, I’m somehow not fitting it because I’m not thin enough or… curvy enough or trying to look sexy enough”). (3) Identities and intersectionality: Appearance pressures vary by gender, sexual orientation, and race/ethnicity (e.g., “I think for non-binary people, the expectation is usually… designated female at birth, white, skinny, masculine-presenting… a lot of people who are non-binary feel pressured into fitting into that”; “On Grindr… you’ll see people’s profiles like ‘No fats, No fems, No insert race here’”). (4) Complexity and resilience: LGBTQ contexts as affirming vs. constraining (e.g., “queer spaces have the ability to be some of the most accepting places in terms of body image and appearance… but they also have the potential to be very… constricting”).
Eating disorder prevention and treatment programs must consider LGBTQ young people’s experiences with dominant societal appearance ideals as well as LGBTQ-specific pressures, experiences of stigma, and resilience when adapting programs for this underserved population.
Sources of Support
Harvard Strategic Training Initiative for the Prevention of Eating Disorders; Leadership Education in Adolescent Health Training Grant #T71MC00009, MCH, HRSA.
© 2018 Published by Elsevier Inc.