LGBTQ+

 LGBTQ+ in the PEACE community

At the PEACE pathway we recognise that LGBQ+ people with EDs may experience specific difficulties or barriers that influence the presentation of their ED, whether they seek help, and how they engage in treatment. Understanding how best to support people within the LGBTQ+ community experience eating disorders may be particularly relevant for autistic people, as research suggests that autistic people may be more likely to identify as LGBTQ+ compared to their neurotypical peers.

LGBTQ+ stands for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning. The ‘+’ is to acknowledge that not all identities fall into these categories. These are self-identification terms which individuals can use to describe their sexual orientation and their gender identity. Autistic people, as with anyone else, can identify with any of these terms or move between them.

We know that LGBTQ+ people experience higher rates of mental health problems, including eating disorders. When compared to the general population, discrimination due to gender identity has been linked with higher rates of attempted suicide (1.6% vs 41%) (Grant et al, 2011). Research has shown that eating disorder diagnoses are highest amongst those who identify as a sexual minority (i.e. not heterosexual) and those who identify as transgender (Diemer et al, 2015). Research has suggested that for males who identify in a sexual minority, the rate of eating disorder symptoms is ten times higher than those of a heterosexual man (Strother et al, 2012).

There are unique stressors experienced by those in the LGBTQ+ community, from coming ‘out’ to being bullied and discriminated against. These stressors can contribute to the mental health of an individual, often in a negative way causing anxiety, low self esteem and depression. The experiences of LGBTQ+ people may also change how they perceive mental health problems, and whether they seek help. Many people in the LGBTQ+ community will have experienced accusations that their sexual orientation or gender identity is related to their mental health and so may reject or distance themselves from any associations with mental health conditions such as an eating disorder or autism. Together, these barriers, discrimination and/or prejudice for both their mental health and their sexual orientation or gender identity can stop someone speaking openly, seeking appropriate support or having a clear identity. This discrimination can occur anywhere from school, to work, to the home environment to mental health treatment settings. 

Understanding the experiences of LGBTQ+ people experiencing eating disorders, and implications for treatment and support, may be particularly relevant for some autistic people. Research suggests that a higher percentage of autistic people identify outside of ‘conventional’ genders (George & Stokes, 2018) and that there is an increased non-heterosexual identity amongst those with autism and yet there is very little support or acknowledgement specifically for this group who may be experiencing stigma related both to their identity as an autistic person, and their LGBTQ+ status. More research is needed to explore the intersection between autistic and LGBTQ+ identities.

It is important to note that being autistic or having an eating disorder does not ‘cause’ your gender identity or sexual orientation, but it may be linked to how you experience and understand it.

There is a lack of research into autistic people in the LGBTQ+ community and an urgent need for it (Bennett & Goodall, 2016; Øien, Cicchetti, & Nordahl-Hansen, 2018), as these numbers are thought to be higher due to potentially limited social connections resulting in reduced positive LGBTQ+ role models (Hillier et al, 2020). Although no research has been done on it, these rates could be higher in those with eating disorders and autism as we know that both of these can lead to reduced social connections (REF).

How to address bullying

People are bullied for being part of the LGBTQ+ community, people are bullied for being part of the autistic community and people are bullied for having eating disorders. Being in all three of these groups may increase a person’s chances of being bullied and rejected. Although someone with autism or an eating disorder may have small social circles, it is important to ensure that this is a choice and not due to stigmatisation or prejudice.

If you suspect that someone is being bullied, ask them about their experience with it. Bullying can add to a huge strain on someone’s mental health and it is important that this is acknowledged and addressed as soon as possible. Bullying can be a very confusing social situation for someone with autism and they may misinterpret the situation, this can often make it easier for people to pick on them as there may not be the same repercussions. Although they may not fully understand the intent of a person at times, there can still be long-term damaging repercussions to their self-esteem and a need for the bullying to stop.

You can ask the individual about their experience, you can give some psychoeducation to the bullies, and if appropriate you can report the bullies. This is the same when the bullying is ‘cyber’. You are able to report accounts on Instagram, Twitter and Facebook. When the bullying is taking place in a online forum, there is often a ‘moderator’ who can also be approached. This is important not only for the person being bullied, but also for other potential victims of the bully who are not able to speak up.

If you think that you might be being bullied, try and reach out to someone for support. Even if you are unsure it may help to discuss your experiences with someone else. If you have a trusted family member or a friend, you can utilise these support networks but if you feel unable to discuss these issues with your friends or family then there are a number of other support networks (see the bottom of this article for contact details).

How to support someone with their recovery

Some LGBTQ+ people with mental health conditions such as eating disorders find that the process of seeking treatment and pursuing recovery challenging as there are several barriers. Due to these barriers, someone may not seek support, thinking that they may not be accepted for who they are and that they may be discriminated against. By increasing awareness of these barriers, we can help to support those in the LGBTQ+ community with autism and an eating disorder, giving them confidence that they will receive care and treatment that recognises and respects their identities.

There are several ways we can reduce these barriers: 

1. We can increase awareness and educate ourselves. By talking about the struggles an LGBTQ+ person with autism and an eating disorder may face, we can help to build a more accepting and understanding society. Clinicians, in particular, will need to be educated on these barriers in order to better support and understand the experience of those who are impacted.
2. We should create gender neutral spaces as a society. This can be particularly important in treatment settings where there are ‘male’ and ‘female’ spaces, such as bathrooms. Having gender neutral spaces can increase the feeling of acceptance to someone who may be struggling with their identity.
3. When meeting someone for the first time, include pronoun identifications in your introduction. Ask which pronouns they go by and do not assume someone’s gender identity.
4. Introduce specialised sex education programs to be more inclusive for those with autism and comorbid mental health conditions such as eating disorders. Acknowledging the high instances of LGBTQ+ when sex education is first being discussed in schools or other settings could reduce the isolation or barriers someone may be experiencing.
5. Be inclusive and welcoming. Admit that you may not understand someone’s experience fully but also let them know that you want to better understand it and that you want to support them in identifying how they want. Validate their struggles and see how you can help reduce these for the individual.

Accessing Support: 

Albert Kennedy Trust or ‘akt’

Supporting LGBT people between the ages of 16-25 facing homelessness or living in hostile environments. They can help with emergency accommodation, accessing support, advice and connecting you with a mentor. 

Consortium

Use their member directory linked here to find local support

LGBT Switchboard

An LGBT helpline open 7 days a week from 10am-11pm on 0300 330 0630. They also have an instant messaging service, which you can access through their website, 

MindLine Trans+

Free, confidential listening service for people identifying as trans or non-binary, and their friends and families. Open two days a week: Mondays and Fridays 8pm to midnight on 0300 330 5468

MindOut

Mental health service run by and for LGBTQ+ people. Services include telephone support, online chat, peer support. Check here for the latest available support times. 

YouTube

Eating Disorders in the LGBT community: Coming out Twice documentary 

https://www.youtube.com/watch?v=AHZzEPsIuDk

Autism, Anxiety and Being LGBTQ+

https://www.youtube.com/watch?v=I0OeGzrUNO4