The pride framework: a sociocultural-developmental approach for understanding LGBTQ+ adolescents' body image and disordered eating

This theoretical review paper offers a sociocultural-developmental framework for understanding LGBTQ+ adolescents' body image concerns and disordered eating risk. The Pride Framework integrates well-established sociocultural theories and extant empirical research, drawing from objectification theory, the tripartite influence model, minority stress theory, and intersectionality theory. The Pride Framework situates sociocultural appearance pressures within the adolescent developmental context, wherein biological, cognitive, and social transitions exacerbate the likelihood of body image disturbances and eating pathology. Various processes are then posited to link these sociocultural-developmental pressures to body image concerns and disordered eating. Crucially, this framework underscores that LGBTQ+ status itself does not pose a risk for body dissatisfaction and eating disorders. Instead, it is the experience of residing in a society that stigmatizes LGBTQ+ identities that increases youth's vulnerabilities. LGBTQ+ health researchers and practitioners are encouraged to engage in collaborative efforts with the aim of fostering acceptance for LGBTQ+ youth. This, in turn, could support normative adolescent identity exploration processes within sociocultural settings that are both affirming and inclusive, potentially mitigating adverse health consequences associated with body image disturbances.

Eating Disorders in Sexual and Gender Minority Adolescents

PURPOSE OF REVIEW

To consolidate recent literature addressing eating disorders and disordered eating behaviors among sexual and gender minority (SGM) adolescents, including but not limited to lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents.

RECENT FINDINGS

Sexual and gender minority adolescents are at heightened vulnerability to eating disorders and disordered eating behaviors compared to their cisgender and heterosexual peers, potentially due to minority stress, gender norms, objectification, and the influence of the media, peers, and parents. We report findings from recent literature on the epidemiology and prevalence, assessment, mental health comorbidity, quality of life and psychosocial functioning, risk and protective factors, and treatment and interventions for eating disorders in sexual and gender minority adolescents. Addressing eating disorders in sexual and gender minority adolescents requires an integrated approach consisting of screening, tailored treatment, and comprehensive support to address intersectional challenges. Gender-affirming and trauma-informed care approaches may be considered.

The role of minority stress in disordered eating: a systematic review of the literature

PURPOSE

Sexual and gender minorities (SGMs) show a heightened risk of disordered eating compared to heterosexual and cisgender people, a disparity which may be caused by exposure to minority-specific stressors, such as discrimination and violence. This systematic review aims to summarize available evidence on the role of minority stress in disordered eating and SGM-specific aspects.

METHODS

Following PRISMA guidelines, scientific search engines (EBSCO, PUBMED, Web of Science) were screened up to 31st of January 2024, including English-language original research papers containing analyses of the relationship between minority stress and disordered eating. 2416 records were gathered for screening. After application of inclusion and exclusion criteria, thematic analysis was conducted regarding 4 research questions: effects of minority stress on disordered eating, mediating factors, specificities of SGMs and differences between identity categories.

RESULTS

30 studies were included. Several aspects of minority stress are reliably associated with different forms of disordered eating. The relationship between minority stressors and disordered eating is mediated by aspects such as shame, body shame, or negative affect. SGMs show several specificities, such as the presence of a role of LGBTQIA + communities and additional gender-related pressures. Bisexual people and gender minorities appear to feature comparatively higher risks, and gender-related factors shape paths leading to disordered eating risk.

CONCLUSION

Minority stress is an important predictor of disordered eating, making SGM people's health particularly at risk. Institutional and organizational anti-discrimination policies are needed, as well as further research. Clinical interventions may benefit from exploring and incorporating how minority stressors impact SGM people. Evidence level I-Systematic review.

Embodying loving kindness: Examining self-compassionate writing tasks and body satisfaction among transgender and non-binary people

Using an experimental posttest-only control group design, the purpose of this study was to examine the effects of self-compassionate writing exercises on transgender and non-binary participants' body satisfaction, gender identity pride, and internalized transphobia. A total of 238 transgender people participated in this study (Mage = 28.27, SD = 8.12). Participants were randomly assigned to a self-compassionate writing task focusing on their gender identity, a self-compassionate writing task focusing on their body image as a transgender person (i.e., gendered body image), and a control condition, which required them to write about a neutral day in their lives. Results demonstrated that those in the gendered body image self-compassionate condition reported higher state-level effects of body satisfaction following the intervention than those in the control condition. No significant effects were observed for condition on state-level gender identity pride or internalized transphobia. Results also demonstrated that non-binary participants reported higher levels of gender identity pride than trans femme participants. Exploratory post-hoc analyses revealed that gender identity pride moderated the effect of condition on body satisfaction. Compared to those in the control condition, participants in the gendered body self-compassionate condition with moderate and high levels of gender identity pride reported higher levels of body satisfaction. Results demonstrate potential beneficial effects of brief self-compassionate writing exercises on transgender peoples' body satisfaction.

Use of the Heterosexist Harassment, Rejection, and Discrimination Scale With Different Sexual Orientation, Gender, and Racial/Ethnic Groups: An Examination of Measurement Invariance

The Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) is one of the most commonly used measures of sexual orientation-related discrimination, but little is known about its psychometric properties across different sexual orientations, gender, and racial/ethnic groups. A three-factor model was initially obtained, but most studies treat the HHRDS unidimensionally. Therefore, we tested whether the HHRDS exhibited measurement invariance across sexual orientation, gender, and racial/ethnic groups among 792 sexual minority young adults (aged 18-29) who participated in an online study. Across models, the three-factor solution fit better than the one-factor solution. All models achieved configural invariance and most achieved metric invariance; none of the considered models achieved scalar invariance (1-3 items were not equivalent across groups, depending on the comparison). Findings suggest that the HHRDS generally functions equivalently across sexual orientation, gender, and racial/ethnic groups, but some caution in interpreting scores is warranted.

Testing the associations between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the pantheoretical model of dehumanization: A study in Chinese transgender adults

As an integrated framework informed by the Minority Stress Model and Objectification Theory, the Pantheoretical Model of Dehumanization was proposed to better understand mental health outcomes in transgender individuals. With a sample of 200 Chinese transgender adults, the present study tested the associations and potential mechanisms between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the Pantheoretical Model of Dehumanization. Correlation and regression analyses were used. Results showed that internalized cisgenderism was positively related to body shame, psychological distress, disordered eating, non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts. Body shame showed significant indirect effects in the association between internalized cisgenderism and suicide attempts, and in the associations between internalized cisgenderism and psychological distress, disordered eating, and NSSI. In addition, body shame had significant indirect effects in the associations between body surveillance and disordered eating, NSSI, and suicide attempts, and in the association between body surveillance and psychological distress. As the first study testing the associations of core variables in the Pantheoretical Model of Dehumanization in a Chinese transgender sample, the findings largely supported the model in describing meaningful variance in Chinese transgender adults' psychological distress, disordered eating, and self-injurious thoughts and behaviors.

Gender and Media Representations: A Review of the Literature on Gender Stereotypes, Objectification and Sexualization

Media representations play an important role in producing sociocultural pressures. Despite social and legal progress in civil rights, restrictive gender-based representations appear to be still very pervasive in some contexts. The article explores scientific research on the relationship between media representations and gender stereotypes, objectification and sexualization, focusing on their presence in the cultural context. Results show how stereotyping, objectifying and sexualizing representations appear to be still very common across a number of contexts. Exposure to stereotyping representations appears to strengthen beliefs in gender stereotypes and endorsement of gender role norms, as well as fostering sexism, harassment and violence in men and stifling career-related ambitions in women. Exposure to objectifying and sexualizing representations appears to be associated with the internalization of cultural ideals of appearance, endorsement of sexist attitudes and tolerance of abuse and body shame. In turn, factors associated with exposure to these representations have been linked to detrimental effects on physical and psychological well-being, such as eating disorder symptomatology, increased body surveillance and poorer body image quality of life. However, specificities in the pathways from exposure to detrimental effects on well-being are involved for certain populations that warrant further research.

Body image, interoceptive awareness, depression and eating disorder symptoms: Within-group variability among sexual minority women

This study investigates within-group differences in body image concerns among sexual minority women and their related association with eating disorders and depression. Cross-sectional data were collected in 2017 and analysed in 2020 from 201 sexual minority women in the United States. Latent profile analyses and post hoc comparison analyses were conducted to investigate within-group variability in body image concerns and to understand their impact on depressive and eating disorder symptoms. Results suggested that a 5-class solution best fit the data, with five distinct profiles emerging in patterns of interoceptive awareness, sociocultural attitudes toward appearance, body shame, body surveillance and appearance anxiety. Significant differences in mean scores of depressive and eating disorder symptomatology emerged among the profiles; groups that reported low interoceptive awareness and high body image concerns experienced greater levels of eating disorder and depressive symptoms, compared to groups with average or higher levels of interoceptive awareness and average or lower body image concerns. Results underscore the significant within-group variability that exists for sexual minority women with regard to the prevalence of body image concerns, depressive symptoms and eating disorder symptoms. Efforts that aim to increase interoceptive awareness (for example, mindfulness) alongside strategies aimed at addressing negative body image concerns may be particularly effective avenues for future depression and eating disorder prevention in this diverse group. Our reporting adheres to the STROBE research reporting checklist.

PTSD Symptoms and Hazardous Drinking Indicators among Trauma-Exposed Sexual Minority Women during Heightened Societal Stress

Trauma-exposed sexual minority women (SMW) are at elevated risk of posttraumatic stress disorder (PTSD) and hazardous drinking compared to trauma-exposed heterosexual women. To understand whether these problems might be exacerbated during times of elevated societal stress, we collected data from a New York-based sample of trauma-exposed SMW between April 2020 and August 2020, a period of notable, compounding societal stressors, including: (a) living in or near one of the first epicenters of the coronavirus disease 2019 (COVID-19) epidemic in the United States and (b) living through multiple high-profile occurrences of racism-related police violence and subsequent racial unrest. SMW (n = 68) completed online self-report questionnaires related to trauma, PTSD symptoms, and alcohol use, and a subset (n = 29) completed semi-structured qualitative interviews. PsycINFO was searched with terms related to SMW, PTSD, and alcohol use to identify studies with samples of SMW from articles published within the last 10 years to which we could compare our sample; this produced nine studies. Welch's t-tests and Chi-square analyses revealed that SMW within our sample reported significantly higher PTSD symptom severity, probable PTSD, and hazardous drinking indicators (i.e., alcohol use disorder and heavy episodic drinking) between April 2020 and August 2020 compared to similar samples (i.e., trauma-exposed SMW and general samples of SMW) assessed previously. Qualitative reports also indicated that the societal stressors of 2020 contributed to mental and behavioral health concerns. These results underscore the need for integrated PTSD and alcohol use prevention and intervention efforts for trauma-exposed SMW during times of heightened societal stress.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2006132 .

Understanding eating disorder symptoms in same-gender couples: social environmental factors

BACKGROUND

Sexual minority individuals are at disproportionately greater risk for eating disorders, yet little is known about the ways in which factors in the social environment relate to eating disorder symptoms in this population. Utilizing an ecological systems theory framework, we investigated the relative relationships of macro level (i.e., internalization of sociocultural attitudes about appearance) and micro level (i.e., quality of romantic relationship) social environment influences.

METHODS

Men (n = 144) and women (n = 144) in committed same-gender relationships were recruited as a dyad and completed study questionnaires, including multiple measures of eating disorder symptoms. Multilevel models controlling for key variables (e.g., body mass index) were used to examine gender differences, main effects, and interactions.

RESULTS

Men reported greater internalization of sociocultural attitudes and uncontrolled eating. Greater internalization of sociocultural attitudes was related to greater eating pathology across all measures. For men, greater relationship quality was related to less uncontrolled eating.

CONCLUSIONS

Individuals in same-gender relationships experience macro (e.g., sociocultural) level vulnerability factors in relation to disordered eating; however, internalization of sociocultural attitudes may be greater for men. Support at the microsystem level in the form of a high quality committed romantic relationship appears to be helpful protection against uncontrolled eating for men.

Rationale and Design of an Ecological Momentary Assessment Study Examining Predictors of Binge Eating Among Sexual Minority and Heterosexual Young Women: Protocol for the Health and Experiences in Real Life (HER Life) Study

BACKGROUND

Previous research has identified health disparities between sexual minority and heterosexual women, including increased rates of obesity and binge eating in sexual minority women. Established predictors of binge eating behavior include negative emotions and sociocultural processes; however, these studies are generally conducted in samples of young women where sexual identity is not known or reported. There is a dearth of research evaluating how sexual minority-specific factors (eg, minority stress and connectedness to the lesbian, gay, bisexual, transgender, and queer community) may affect binge eating in sexual minority women. In addition, no studies have examined these processes in racially diverse samples or considered how intersecting minority identities (eg, Black and sexual minority) may affect eating behaviors.

OBJECTIVE

The Health and Experiences in Real Life (HER Life) Project aims to clarify real-world predictors of binge eating in young heterosexual and sexual minority women using ecological momentary assessment. The role of affective, social, and health behavior factors in binge eating will be examined for all women (aim 1), and sexual minority-specific predictors will also be considered for sexual minority women participants (aim 2). Person-level moderators of race, body- and eating-related factors, and sexual minority-specific factors will also be examined to better understand how real-world binge eating predictors may differ for various demographic groups (aim 3).

METHODS

Researchers aim to recruit 150 sexual minority and 150 heterosexual women from across the United States, including at least 50 Black women for each group, using web-based recruitment methods. The eligibility criteria include identifying as a woman, being aged between 18 and 30 years, and having had at least two binge eating episodes in the last 2 weeks. Participants must endorse being only or mostly attracted to men (considered heterosexual) or only or mostly attracted to women or having a current or most recent female partner (considered sexual minority). Eligible participants complete an initial web-based baseline survey and then 14 days of ecological momentary assessment involving the completion of a morning and before-bed survey and 5 prompted surveys per day as well as a user-initiated survey after binge eating episodes. The data will be analyzed using a series of multilevel models.

RESULTS

Data collection started in February 2021. We have currently enrolled 129 sexual minority women and 146 heterosexual women. Data collection is expected to conclude in fall 2022.

CONCLUSIONS

The Health and Experiences in Real Life Project aims to elucidate potential differences between sexual minority and heterosexual women in within-person factors predicting binge eating and inform eating disorder interventions for sexual minority women. The challenges in recruiting sexual minority women, including the determination of eligibility criteria and considerations for remote data collection, are discussed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41199.

Factors that drive mental health disparities and promote well-being in transgender and nonbinary people

Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions.

Buffering an Objectifying Culture: Interpersonal Sexual Objectification, Self-Objectification, and Attachment Anxiety

In this article, we report two studies that examined the dynamics between interpersonal sexual objectification, self-objectification, and individuals’ attachment in romantic relationships. Study 1 was based on data from 392 college students ( Mage = 21.42 years, 66.8% women). Results showed positive associations between interpersonal sexual objectification, self-objectification, attachment anxiety, and attachment avoidance among women. For men, significant and positive associations were only observed between interpersonal sexual objectification and self-objectification and between self-objectification and attachment anxiety. Study 2 was a 6-month longitudinal study where we recruited participants through CloudResearch ( n = 638, Mage = 24.26 years, 55.8% women at Time 1; n = 283, Mage = 24.43 years, 56.9% women at Time 2; return rate = 44.36%). Results from longitudinal analyses showed that women reported stronger stability in self-objectification than men, and for both women and men, their attachment anxiety predicted increased self-objectification. Additionally, in both studies, women reported higher levels of interpersonal sexual objectification, self-objectification, and attachment anxiety than men. Overall, the findings suggest that high-quality relationships may help buffer the negative effects engendered by an objectifying culture. Based on our results, we recommend that clinicians and parents work to foster secure and healthy relationships as a means of reducing the extensive negative repercussions of objectification.

Associations between body dissatisfaction and relationship functioning among same-sex female couples: An actor-partner interdependence model

Nearly all past research about body dissatisfaction and romantic relationship factors is among heterosexual couples; little is known about these associations in sexual minority couples. The present study aimed to fill gaps in the current literature by using actor-partner interdependence models (APIMs) to examine dyadic patterns of association between body dissatisfaction and different aspects of relationship functioning among same-sex female couples. Participants were 163 same-sex female romantic dyads (326 women) between the ages of 18-35 years who completed measures of body dissatisfaction and relationship factors. Results from significance testing of actor and partner effects indicated higher levels of women's own body dissatisfaction were associated with lower levels of their own, but not their partner's, relationship satisfaction, closeness, sexual satisfaction, and intimacy/connectedness. Significance testing alone indicated that the association between one's own body dissatisfaction and their partner's relationship satisfaction was not significant. However, dyadic pattern testing identified a partner pattern for this effect, which suggests that the association between one's own body dissatisfaction and one's own relationship satisfaction is similar in magnitude and direction as that between an individuals' own body dissatisfaction and their partner's relationship satisfaction. In this study, women's own body dissatisfaction was found to be negatively associated with their own relationship functioning, which is consistent with findings of women in male-female couples. Thus, these findings highlight the important role that body dissatisfaction plays in women's relationship experiences. More research is needed to better understand potential cross-partner effects of body dissatisfaction and relationship factors in same-sex female couples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Demographic and sociocultural predictors of sexuality-related body image and sexual frequency: The U.S. Body Project I

Body image is a critical component of an individual's sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one's body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.

Not All the Same: Examining Asian American Women’s Self-Objectification Processes Using a Latent Class and Cultural-Specific Approach

Past research has shown that Asian American women are subject to distinct forms of sexism and racism that can influence culture-specific appearance evaluations. However, no studies have examined within-group differences in self-objectification processes. To address this gap, we used latent class analysis. Our study had three aims: (a) identify subgroups (e.g., latent classes) of Asian American women ( N = 554) based upon their general and group-specific self-objectification processes, (b) examine the racial objectification predictors (e.g., general racism, gendered racial microaggressions, and racial identity) of latent class membership, and (c) examine the relation between the classes and disordered eating and depression. Results of the latent class analysis yielded four classes: (a) High Self-Objectification class (37.2%), (b) Moderate Self-Objectification class (40.1%), (c) Body Conscious class (7.3%), and (d) Appearance Acceptance class (15.5%). The High Self-Objectification class reported significantly higher rates of disordered eating and depression. Women were more likely to be in the High Self-Objectification class if they experienced higher levels of gendered racial microaggressions and racial dissonance. Results can advance the literature by demonstrating significant within-group variability in self-objectification processes among Asian American Women and offer valuable clinical implications for targeting high-risk groups.

A Test of Objectification Theory with Sexual Minority Women

With this study, we aimed to advance objectification theory research with sexual minority women by examining the understudied roles of appearance anxiety and interoceptive awareness concomitantly with other key variables, including sexual objectification experiences, internalization of cultural appearance standards, body surveillance, and body shame. We also examined depressive symptoms as a criterion variable in addition to eating disorder symptoms. Survey data from 201 sexual minority women were analyzed. Manifest variable path analysis of the hypothesized model explained 35% and 27% of the variance in eating disorder and depressive symptoms, respectively. Results revealed a distinct pattern of cross-sectional direct and indirect relations for eating disorder and depressive symptoms. Specifically, body shame was a key unique correlate of eating disorder symptoms and linked internalization of cultural appearance standards and body surveillance with eating disorder symptoms. Appearance anxiety was a key unique correlate of depressive symptoms and linked internalization of cultural appearance standards and body surveillance with depressive symptoms. Sexual objectification experiences and interoceptive awareness generally did not yield significant unique direct or indirect relations in the model. These findings suggest distinct and complementary points of intervention to mitigate eating disorder and depressive symptoms for sexual minority women.

Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual- and community-level factors

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (β = 0.15, p = .013) and lower body esteem (β = -0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals' emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.

Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight

OBJECTIVE

This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity.

METHODS

Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant.

RESULTS

Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period.

CONCLUSIONS

Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.

Psychosocial correlates of body esteem and disordered eating among sexual minority adolescent girls

The present study examined whether body esteem mediates the associations between psychosocial factors, including peer victimization and parent-adolescent relationship quality, and multiple categories of disordered eating (DE) within a diverse sample of adolescent sexual minority (SM) girls. Participants were 528 girls, aged 14-18 years, recruited as part of a larger online study on LGBTQ + adolescent health. Participants anonymously completed self-report measures of parent-adolescent relationship quality, sexual orientation-based victimization, body esteem, and DE behaviors, including binge eating, purging, and caloric restriction. Parent-adolescent relationship quality was positively associated with SM adolescent girls' body esteem, and some aspects of body esteem subsequently mediated the associations between parent-adolescent relationship quality and DE behaviors. Experiences of sexual orientation-related victimization were also positively related to endorsement of caloric restriction. However, no significant indirect effects were observed between sexual orientation-related victimization and DE via body esteem. These results suggest parents could influence their SM daughters' DE behaviors via body esteem, and SM girls may be engaging in caloric restriction if they experience victimization, regardless of their body esteem.

The role of sexual orientation in the relationships between body perception, body weight dissatisfaction, physical comparison, and eating psychopathology in the cisgender population

PURPOSE

Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of different psychiatric disorders. The sexual orientation is a fundamental but understudied aspect in this field, and, for this reason, the purpose of this study is to improve knowledge about the relationships among BWD, visual body size-perception, and sexual orientation.

METHODS

A total of 1033 individuals participated in an online survey. Physical comparison, depression, and self-esteem was evaluated, as well as sexual orientation and the presence of an eating disorder. A Figure Rating Scale was used to assess different valences of body weight, and mediation analyses were performed to investigated specific relationships between psychological aspects.

RESULTS

Bisexual women and gay men reported significantly higher BWD than other groups (p < 0.001); instead, higher body misperception was present in gay men (p = 0.001). Physical appearance comparison mediated the effect of sexual orientation in both BWD and perceptual distortion. No difference emerged between women with a history of eating disorders and without, as regards the value of body weight attributed to attractiveness, health, and presence on social media.

CONCLUSION

This study contributes to understanding the relationship between sexual orientations and body image representation and evaluation. Physical appearance comparisons should be considered as critical psychological factors that can improve and affect well-being. The impact on subjects with high levels of eating concerns is also discussed.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

‘She Should Not Be a Model’: The Effect of Exposure to Plus-Size Models on Body Dissatisfaction, Mood, and Facebook Commenting Behaviour

Objectives: The present study investigated the exposure effect of plus-size models on body dissatisfaction and mood, and the nature of participants’ commenting behaviour towards images of plus-size models. Method: The study was comprised of 92 female university students who were exposed to Facebook photos of plus-size models. Participants were randomly allocated to having the exposed photo paired with positive, negative, or neutral comments, and participants were asked to leave an anonymous comment on each picture. Results: Results showed that participants had less body dissatisfaction and better mood after exposure to plus-size models regardless of the comment condition. Additionally, comment condition significantly influenced the type of comments participants contributed — in photos paired with negative comments, participants were significantly more likely to leave negative comments themselves, with 40% of participants leaving negative comments compared with 4% in the positive condition, and 12% in the neutral condition. Conclusion: This study provides evidence that the negative comments of plus-size models can encourage bystanders to contribute negative comments themselves; reinforcing the need to develop better protocols to oppose cyberbullying and encourage an online environment of positivity.

The role of sexual minority stress and community involvement on disordered eating, dysmorphic concerns and appearance- and performance-enhancing drug misuse

Prior research has established that sexual minority (SM) individuals are more likely to experience disordered body image behaviors and concerns than heterosexual individuals. This increased risk may be explained by minority stress theory - that SM individuals are subject to SM-specific stressors, leading to health disparities - but this has not yet been fully examined. Furthermore, this theory states that SM community involvement may mitigate negative outcomes. The current study examines whether minority stress is associated with screening positive for an eating disorder, screening positive for body dysmorphic disorder, and appearance- and performance-enhancing drug misuse in a sample of SM individuals (483 women and 479 men) in the US. This study also examines whether the effect of minority stress is moderated by SM community involvement. Logistic regressions were conducted for each type of minority stress (internalized homophobia, sexual orientation concealment, and heterosexist discrimination) interacting with community involvement. After correction for multiple comparisons, all minority stressors and community involvement were positively associated with increased odds of disordered body image behaviors and concerns, with no evidence of a buffering effect for community involvement. The lack of a buffering effect is contrary to minority stress theory and may inform future prevention efforts.

State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women

This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.

Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment

Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care.

OBJECTIVE

To (a) compare history of abuse-related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs.

METHOD

We analyzed data from 2,818 individuals treated at a large, US-based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed-effects models.

RESULTS

SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE-Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE-Q scores did not differ between SGMs and CHs.

DISCUSSION

Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs-possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.

An Inhospitable World: Exploring a Model of Objectification Theory With Trans Women

In this study, we investigated key tenets of objectification theory, a prominent model of body image disturbance, as it relates to trans women's disordered eating and intention to obtain silicone injections-a specific health risk for this population. We also incorporated appearance congruence, or the degree to which an individual personally feels that their gender expression matches their gender identity, into the objectification theory model. Results of a structural equation model using data from a sample of 173 trans women from the United States indicated that the basic objectification theory model held among this sample and that appearance congruence was associated negatively with body surveillance. However, appearance congruence did not have significant direct or indirect links (via body surveillance and body shame) with disordered eating or intention to obtain silicone injections. Thus, disordered eating and intention to obtain silicone injections are potential negative outcomes of the process of objectification among trans women, and appearance congruence does not appear to be uniquely linked to health risks associated with internalization of cultural standards of attractiveness, body surveillance, and body shame. Our findings support the application of the tenets of objectification theory with trans women as they apply to disordered eating and intention to obtain silicone injections and also indicate the need to identify other positive influences on trans women's body image to counteract internalization of cultural standards of attractiveness.

Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature

BACKGROUND

According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM).

MAIN

This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals).

CONCLUSION

LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.

Validation of the Body Appreciation Scale-2 and relationships to eating behaviors and health among sexual minorities

Although the study of positive body image continues to expand, researchers have predominantly focused the study of this newer construct among presumed heterosexual participants. The purpose of the present study was to examine the factor structure of a measure of positive body image, the Body Appreciation Scale-2 (BAS-2), among sexual minority participants. The present study also sought to psychometrically validate the BAS-2 among sexual minorities by assessing its relationship with other facets of positive body image, including functionality appreciation and body image flexibility, as well as other related constructs, such as body dissatisfaction, disordered eating behaviors, intuitive eating behaviors, and physical and mental health. Results from a confirmatory factor analysis of 223 sexual minority adults (M_age = 32.45, SD = 10.07) indicated that the BAS-2 displayed strong factorial validity with a unitary factor structure. Furthermore, the BAS-2's construct validity was supported based on correlations with other measures of positive body image, body dissatisfaction, and disordered eating behavior. Results from this cross-sectional study supported a relationship between body appreciation and intuitive eating behaviors, as well as physical and mental health among sexual minority participants. These findings provide an initial understanding of body appreciation and other related constructs among sexual minority individuals.

The Impact of a Dissonance-Based Eating Disorders Intervention on Implicit Attitudes to Thinness in Women of Diverse Sexual Orientations

Dissonance-based body image programs have shown long-term effectiveness in preventing eating disorders and reducing risk factors for eating disorders in women. Here we report on the potential for one such intervention to impact on implicit attitudes toward thinness as well as an explicit measure of eating attitudes, across a sexually diverse group of young women. The Succeed Body Image Programme was adapted to remove heteronormative assumptions and was delivered to a final sample of 56 undergraduate women who reported their sexual orientation as either “predominantly heterosexual” (our term; 1 or 2 on a 7-point Kinsey scale, n = 38) or non-heterosexual (3–7 on the Kinsey scale, n = 18). Before and after the intervention, they completed the Eating Attitudes Test-26, and an associative reaction time task based on the Implicit Association Test, in which bodies of low and higher weight were paired with socially desirable or undesirable traits. A total of 37 predominantly heterosexual women completed a control intervention in which they read NHS leaflets on eating disorders and healthy weight. Results showed that the intervention made predominantly heterosexual participants less prone, versus control, to associating thinness with positive traits on the IAT and all women completing the intervention reported a lower level of disordered eating attitudes at post- than pre-test. Non-heterosexual women, however, showed a non-significant increase in thin-bias on the IAT, perhaps due to their low baseline. These results imply that intensive dissonance-based programs can change attitudes at the automatic, implicit level as well as merely giving women tools to overcome those implicit attitudes.

“I Wanna Be Sedated”: A Closer Examination of Psychosocial Factors Associated With Past-Year Tranquilizer Use Among National Sample of Sexual Minority Adults

Sexual minorities are at increased risk of substance use disorders. Gaps in the research exist regarding tranquilizer use among sexual minorities. Identifying risk factors associated with tranquilizer use may assist public health professionals in developing specific interventions for this vulnerable population. The present study examined potential factors associated with past-year tranquilizer use among a national sample of sexual minorities. A secondary data analysis of the 2017 National Survey on Drug Use and Health was conducted. Results revealed that one in five (21.9%) sexual minorities used a tranquilizer within the past year. Associated risk factors included being female, 18 years of age or older, past-year use of illicit drugs, and having lost interest or pleasure in once pleasurable activities. Findings from the present study can assist prevention professionals in further developing and implementing initiatives to mitigate tranquilizer use among sexual minorities.

Femininity, masculinity, and body image in a community-based sample of lesbian and bisexual women

This study expands the literature on body image among lesbian and bisexual women by examining the relationship between self-perceived gendered personality traits and expressions (i.e., sense of self in relation to cultural constructions of femininity and masculinity) and body satisfaction, a key body image construct. We used data from Wave 3 (2010-2012) of the Chicago Health and Life Experiences of Women (CHLEW) study. The CHLEW includes a novel measure of gender expression, with masculinity and femininity as distinct but overlapping constructs. In the large analytic sample (N = 553), we found both similarities and differences in the association between femininity/masculinity and body image in lesbian and bisexual women. Bisexual women reported significantly lower body satisfaction than lesbian women. Higher masculinity was associated with greater body satisfaction in the full sample, but the association was stronger for bisexual than lesbian women. Femininity was positively associated with body satisfaction only for bisexual women. These findings suggest that masculinity and femininity play different roles in body satisfaction for lesbian and bisexual women and highlight the importance of disaggregating sexual identity in studies of sexual minority women's health. Clinicians should routinely ask about sexual identity and gender expression, especially when presenting concerns involve body image or disordered eating.

Does it Get Better? Change in Depressive Symptoms from Late-Adolescence to Early-Adulthood, Disordered Eating Behaviors, and Sexual Identity

Sexual minority youth are often described as at-risk for mental health comorbidities, including disordered eating behavior (DEB) and depression. This study assesses differences in late-adolescent DEB and depressive symptoms among gay/lesbian, bisexual, or mostly-heterosexual individuals, and how their symptoms change across early-adulthood. While sexual minority youth were more likely to report DEB and elevated depressive symptoms in late-adolescence relative to exclusively heterosexual peers, gay/lesbian individuals experienced improvement in early-adulthood depressive symptoms. Conversely, bisexual individuals maintained elevated depressive symptoms into early-adulthood, and additional depressive symptoms associated with DEB. DEB may be a unique risk-factor shaping the mental health of bisexual youth.

Advancing Research on LGBTQ Microaggressions: A Psychometric Scoping Review of Measures

Understanding the nature and consequences of LGBTQ microaggressions is critical to fostering equity and wellbeing among sexual and gender minorities. Yet little guidance is available for researchers seeking psychometrically robust measures of subtle LGBTQ slights, invalidations, and insults. To address this gap, we conducted a scoping review of multi-item quantitative measures that included at least one question addressing LGBTQ microaggressions. This article reports the study characteristics and psychometric properties of 27 original measures we identified and their subsequent adaptations. The article concludes with an assessment of strengths and limitations of LGBTQ microaggression measurement, highlighting aspects of measurement innovation on which future researchers can build. As microaggressions remain a powerful and underexplored mechanism of sexual and gender minority oppression, this review will help to both advance methodological quality in this critical research area and enhance our understanding of how microaggressions manifest in the lives of LGBTQ individuals.

How Do Feminist-Identified Women Cope With Discrimination? A Feminist Standpoint and Grounded Theory Study

Women experience a higher incidence of mental health concerns compared to men, and scholars have located these challenges within a discriminatory sociocultural context. Although scholars have suggested that feminist attitudes may shield women from discrimination, research on the protective role of feminist attitudes is discrepant and suggests that there are distinct differences between those who do and do not self-identify as feminist; namely, self-identifiers may be more protected in the face of discrimination. Utilizing grounded theory and intersectional feminist standpoint methodologies, in this study we sought to understand the ways that self-identified womanist and feminist women cope with discrimination. We found that women’s feminist and cultural identities intersected, each informing the other and influencing coping mechanisms and well-being. Moreover, results demonstrated that feminist women call upon a variety of different coping mechanisms in response to discrimination, including advocacy, social support, self-care, cognitive processes, disengagement, connecting to one’s femininity, and religion and spirituality. Although possessing a feminist and/or womanist identity appeared to be protective in some cases, at other times it did not. Some participants expressed feeling marginalized from the feminist community and felt that their greater awareness of oppression was an additional source of distress. Based on these findings, we provide suggestions for mental health clinicians and research scholars.

The Effects of System Justifying Beliefs on Skin-Tone Surveillance, Skin-Color Dissatisfaction, and Skin-Bleaching Behavior

In two studies with women living in India (Study 1, n = 177) and African American women in the United States (Study 2, n = 120), we investigated whether skin-tone surveillance, which theoretically is a manifestation of self-objectification, predicted greater skin-color dissatisfaction and greater skin-bleaching behavior. Given the existence of colorism in Indian and American societies, we expected that ideologies that rationalize and perpetuate the status quo would moderate the proposed relations. Results were consistent with objectification theory and system justification theory. The positive relation between skin-tone surveillance and skin-color dissatisfaction was weaker among women of color who more strongly (vs. weakly) endorsed system justifying ideologies, and the positive relation between skin-tone surveillance and skin-bleaching behavior was stronger among women of color who more strongly (vs. weakly) endorsed system justifying ideologies. Our results suggest that self-objectification theorists and researchers should consider culturally specific manifestations of self-objectification as well as protective and legitimating effects of system justifying ideologies. We encourage clinicians and policy makers to use public campaigns and individual-level interventions to target the norms and motivations underlying skin-bleaching. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Rumination mediates the associations between sexual minority stressors and disordered eating, particularly for men

PURPOSE

Sexual minority individuals experience unique minority stressors leading to negative clinical outcomes, including disordered eating. The psychological mediation framework posits that stress related to discrimination, internalized homonegativity, and concealment makes sexual minority individuals more vulnerable to maladaptive coping processes, such as rumination, known to predict disordered eating. The current study examined the influence of sexual minority stressors and rumination on disordered eating, and whether these associations differed between sexual minority men and women. We hypothesized that perceived discrimination, internalized homonegativity, and concealment would be positively associated with disordered eating, and that rumination about sexual minority stigma would mediate these associations.

METHODS

One-hundred and sixteen individuals who identified as sexual minorities completed a survey study assessing perceived discrimination, internalized homonegativity, concealment, rumination about sexual minority stigma, and disordered eating.

RESULTS

Discrimination and concealment uniquely predicted disordered eating in both men and women. However, rumination emerged as a significant mediator for concealment and (marginally) for discrimination for men only. Internalized homonegativity was not uniquely associated with rumination or disordered eating for men or women.

CONCLUSIONS

Sexual minority men who experience discrimination and conceal their sexual orientation may engage in more disordered eating because they dwell on sexual minority stigma. We propose other potential mechanisms that may be relevant for sexual minority women.

Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations

PURPOSE OF REVIEW

This review summarized trends and key findings from empirical studies conducted between 2011 and 2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations.

RECENT FINDINGS

Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males. Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There is still a lack of eating disorder treatment and prevention studies for sexual minorities.

A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

Discrimination against sexual minorities is widespread and has deleterious consequences on victims' psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are "adapted" from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures' construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of "gold standard" measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.

Self-perceived vs. actual physical attractiveness: Associations with depression as a function of sexual orientation

OBJECTIVE

A commonly held belief about physical attractiveness is that attractive individuals are psychologically healthier than less attractive individuals (i.e., the "beauty is good" stereotype). To date, the data on this stereotype and its relationship with depression is limited, with a paucity of literature comparing subjective and objective appearance evaluations and depressive symptoms. Additionally, there is no known research on this relationship among sexual minorities (i.e., gay and bisexual individuals), a highly vulnerable population. The primary aims of the study were to assess the prediction of depression symptoms by subjective and objective appearance evaluation, and secondary aims were to assess the interaction of subjective and objective appearance with sexual orientation.

METHOD

Participants were 4882 American emerging adults (M age=22 years; 2253 males, 2629 females) taken from a U.S. nationally representative dataset (Add Health)

RESULTS

Increased negative subjective appearance evaluation was associated with elevated rates of depressive symptoms (B=-.27, p<.001), while objective appearance evaluation was not significantly related to depressive symptoms. Sexual orientation significantly moderated the relationship between subjective appearance and depression (B=.19, p=.009), with a stronger positive association between negative appearance evaluation and depressive symptoms noted among sexual minority vs. heterosexual participants.

LIMITATIONS

Limitations include cross-sectional design and self-report nature of questionnaires.

CONCLUSIONS

Findings suggest that the 'beauty is good' stereotype may not be valid in regard to depressive symptoms, and that subjective appearance evaluation is a robust predictor of depression, particularly for sexual minority individuals.