ABSTRACT
Chapter 18 reviews the development, prevalence, and treatment of eating disorders in gender and sexual minorities. The concepts of sex, gender identity, gender presentation, and sexuality are all clearly defined. Our understanding of these has moved away from the binary. Healthcare providers must create environments free from marginalization, social stigma, for all patients including lesbian, gay, bisexual, trans, queer/questioning (LGBTQ) individuals of all ages. Sexual minority youth are vulnerable to eating disorders and subclinical behaviors like dieting, bingeing, and diet pill use. While adherence to a certain stereotypical appearance may contribute to body dissatisfaction, minority stress also plays an important role. This refers to excess stress experienced by individuals in stigmatized social categories, as these groups are more likely to be victims of violence, bullying, discrimination, internalized stigma, and social isolation. Gender dysphoria, which refers to dissonance with the sex assigned at birth, should be medically managed using available clear guidelines. Gonadotropin-releasing hormone agonists suppress secondary sex characteristics in transitioning adolescents, followed by gender-affirming sex hormone provision by the mid-teen years. Provision of gender affirmation reduces eating disorders. Trans individuals, compared with cisgender individuals, appear to have the highest rate of eating disorders and disordered eating of any group, in particular those assigned female at birth and identifying as gender non-binary.
