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      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

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          Abstract

          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.

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          Most cited references49

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          Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications.

          In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as well as the mechanisms linking stigma to adverse health outcomes among LGBT youth. Finally, we discuss clinical (eg, cognitive behavioral therapy) and public health (eg, antibullying policies) interventions that effectively target stigma-inducing mechanisms to improve the health of LGBT youth.
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            Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings.

            Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women. (c) 2005 APA, all rights reserved.
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              Comparison of Health and Health Risk Factors Between Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the United States

              Previous studies identified disparities in health and health risk factors among lesbian, gay, and bisexual (LGB) adults, but prior investigations have been confined to samples not representative of the US adult population or have been limited in size or geographic scope. For the first time in its long history, the 2013 and 2014 National Health Interview Survey included a question on sexual orientation, providing health information on sexual minorities from one of the nation's leading health surveys.
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                Author and article information

                Contributors
                janell.mensinger@villanova.edu
                Journal
                Int J Eat Disord
                Int J Eat Disord
                10.1002/(ISSN)1098-108X
                EAT
                The International Journal of Eating Disorders
                John Wiley & Sons, Inc. (Hoboken, USA )
                0276-3478
                1098-108X
                13 March 2020
                April 2020
                : 53
                : 4 ( doiID: 10.1002/eat.v53.4 )
                : 541-554
                Affiliations
                [ 1 ] M. Louise Fitzpatrick College of Nursing Villanova University Villanova Pennsylvania USA
                [ 2 ] Department of Epidemiology and Biostatistics, Dornsife School of Public Health Drexel University Philadelphia Pennsylvania USA
                [ 3 ] Center For Discovery Discovery Behavioral Health Los Alamitos California USA
                Author notes
                [*] [* ] Correspondence

                Janell L. Mensinger, M. Louise Fitzpatrick College of Nursing, 800 E. Lancaster Avenue, Villanova University, Villanova, PA 19185.

                Email: janell.mensinger@ 123456villanova.edu ;

                Author information
                https://orcid.org/0000-0001-7675-8879
                https://orcid.org/0000-0002-5014-8092
                https://orcid.org/0000-0003-3670-5371
                Article
                EAT23257
                10.1002/eat.23257
                7187146
                32167198
                c5506864-ece5-4536-a18b-66fa32f5ef72
                © 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 November 2019
                : 20 February 2020
                : 21 February 2020
                Page count
                Figures: 3, Tables: 4, Pages: 14, Words: 9857
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:28.04.2020

                Clinical Psychology & Psychiatry
                abuse,eating disorder treatment,eating disorder outcome,higher levels‐of‐care,minority stress theory,sexual/gender minority,transgender,trauma

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