Physique Picture Points in LGBTQ+ Folks: Causes and Options

But what happens if our body dissatisfaction warps our body image—i.e., the way we perceive, think about, and treat our bodies? This can lead to body image issues. While it’s not unusual to deal with body image issues at certain points in life (think: a teenager navigating puberty, or a postpartum parent), there are groups of people who are more vulnerable to chronic body images issues—like those in the LGBTQ+ community.

Many factors can contribute to these body images issues, which “often result in less social confidence and connection with community, as well as increased mental health challenges like anxiety, depression, and suicidality,” says Dani Rosenkrantz, PhD, a licensed psychologist specializing in LGBTQ+ mental health and founder of Brave Space Psychology.

This can feel especially true for LGBTQ+ folks who’ve faced judgment or nonacceptance from their families or communities of origin (especially when first coming out). Not only can this increase feelings of isolation and low self-esteem, but also the risk of mental health concerns. “LGBTQ people are also at increased risk of eating disorders and disordered eating, which also are associated with anxiety, depression, substance use, and self-harm,” Rosenkrantz says.

These issues cannot always be completely prevented, but surrounding yourself with support (and finding health care professionals who care and understand) can definitely help. Acknowledging and taking into account systemic issues that contribute to LGBTQ+ mental health concerns is important, too—including anti-LGBTQ+ legislation, societal pressure to conform to straight, cisgender, or white standards, and much more.

Below, we take a closer look at why LGBTQ+ people are at a greater risk for body image issues, what we can do to help, and how body image relates to our overall mental health and well-being.

Why LGBTQ+ people are at higher risk for body image issues

There are a number of complex factors that contribute to body image issues. Some factors are internal (like personality and predisposition), while other factors are external (like someone’s social environment, exposure to media, and their culture’s beauty standards).

Alongside more typical external stressors, Rosenkrantz notes that many LGBTQ+ people face an added burden of identity-based trauma, which can include the following:

• Familial and community rejection
• Limited access to medical care and support
• Experiences of violence and bullying that’s homophobic in nature
• Anti-LGBTQ+ politics and legislation

These factors all combine to make queer and trans people more vulnerable to mental health issues and body dissatisfaction, Rosenkrantz says.

There are also some identity-specific factors that can affect the unique ways queer and trans people relate to their bodies, genders, and sexualities. “This can include desires to make one’s body align more accurately with internal sense of gender as well as with cultural appearance expectations,” says Rosenkrantz. For example, a trans woman may feel pressure to dress hyper-feminine in order to fit in with society’s expectations of femininity.

These desires can also be closely related to gender dysphoria—a feeling of distress that might happen in people whose gender identity differs from their sex assigned at birth, per the Mayo Clinic. Gender dysphoria may then become closely intertwined with body image issues.

Another potential factor at play is internalized homophobia—i.e., a sense of denial or fear of one’s own attraction, which often stems from being socialized into thinking homosexuality is wrong, per The Rainbow Project. Not every person in the LGBTQ+ community will experience internalized homophobia (especially if they are surrounded by supportive people and live in a more accepting place), but some common manifestations of it can include:

• A denial of sexual orientation to yourself and others
• Contempt for members of the LGBTQ+ community
• Low self-esteem
• Fear or withdrawal from friends and family
• Substance abuse
• Poor body image

As a result of any (or all) of the above, LGBTQ+ adults and adolescents have greater rates of eating disorders than their cisgender, heterosexual counterparts, per October 2020 research in the Journal of Eating Disorders. Queer and trans youth are especially vulnerable, with the Trevor Project finding that nearly 9 in 10 LGBTQ+ youth are dissatisfied with their bodies. Likewise, LGBTQ+ youth diagnosed with an eating disorder were nearly four times more likely to attempt suicide, and those without formal diagnoses were still twice as likely, per the Trevor Project.

In short, “LGBTQIA+ people are more likely to have trauma, higher rates of mental illness overall, and higher rates of discrimination and rejection,” says Emily Kipling, LCSW, mental health therapist at FOLX Health, an LGBTQ-focused health-care platform. But these stats should be framed around chronic exposure to discrimination, and not personal failure.

“It is critical to view this increased vulnerability through the lens of the Minority Stress Model³,” says Kipling. “The Minority Stress Model indicates that chronic exposure to stigma, both internal and external, create cumulative psychological distress. We can also see an increase in eating disorders amongst other marginalized communities, such as with racial [and] ethnic identities, which suggests that societal stigma and oppression can affect eating disorder behaviors,” they add. The intersectionality of race and sexual orientation may also amplify this exposure to stigma and stress, per the Human Rights Campaign.

How to address body image issues in the LGBTQ+ community

Healing from body image issues is often more complex than just changing the way you think about yourself. It typically requires a broad approach—and one that involves the help of people who care. While seeking advice from a mental health professional is also advised, your friends and family don’t have to be professionals in order to support you.

Here are some ways you can address body image issues as a queer person yourself, or as an advocate for your LGBTQ+ loved ones and the community:

1. Take a communal approach

Often, queer and trans people are left to “fill the gaps” when it comes to health disparities, and must find solutions on their own. But to truly address body image issues on a societal level, the responsibility can’t rest on the individual who is struggling. Everyone—not just mental health professionals—have a role in LGBTQ+ mental health and body image. Doctors, mental health providers, educators, media creators, faith leaders, parents, and peers all play a part, says Rosenkrantz. In other words, the onus should not be on LGBTQ+ people to educate and initiate change.

“First and foremost, we all need to engage in this world from a body liberation framework that is anti-oppressive and promotes inclusivity, autonomy, fat acceptance, and diversity, because queer folks come in all shapes and sizes,” says Rosenkrantz. “We all need to be trained and empowered to notice and change ways we may be perpetuating harm to create a healthy and inclusive space and a corrective experience that supports the health of LGBTQ+ people.”

Likewise, in order to truly correct body image wounds, we must acknowledge what hurt LGBTQ+ people in the first place—oppression and discrimination. “[Healing requires] validation for the ways body image relates to feeling powerless, rejected, and “not enough” as we are,” says Rosenkrantz.

Healing and community intervention can happen anywhere, including schools, at the dinner table, community events, and in the media. And the younger these interventions can happen, the better, as this will allow new generations of LGBTQ+ youth to feel safe in their bodies and avoid more serious physical and mental health outcomes, like depression and suicide.

2. Start the conversation

“You don’t have to be an expert in trans [and] queer care or eating disorders to start an earnest conversation about it and refer [others] to appropriate resources,” says Kipling. Similarly, as the LGBTQ+ person, you don’t have to have all the answers (or have things all figured out) before opening up to someone you trust.

If you’re the ally in this situation, you have an opportunity to show support, open a dialogue, and provide resources for your LGBTQ+ loved one dealing with body image issues.

As a first step, start educating yourself on LGBTQ+ mental health and health-care disparities. It may be tempting to encourage your loved one to go to the first doctor you can find, but getting help isn’t as simple as booking a doctor’s appointment. Many providers aren’t equipped to handle the needs of LGBTQ+ patients. Instead, consider preparing a list of resources to connect your loved one with affirming care—both locally and online. To start, Rosenkrantz recommends the following:

Finally, start the conversation in a kind, non-judgmental way. Offer the resources you’ve prepared without any expectations of how they’ll react or how the conversation will go. Remember: Everyone’s pace and journey toward self-acceptance is different.

3. Find inclusive health care and training

Over 1 in 3 LGBTQ+ people have had at least one negative experience with a provider—compared to less than 1 in 5 non-LGBTQ+ people, per July 2021 data by KFF. Given how common negative health-care experiences are, addressing body image disparities isn’t just about access to health care, but how respected LGBTQ+ people feel with their doctors. Kipling says it’s crucial for providers to recognize how the health-care system as a whole plays into minority stress and to take the necessary steps to ensure their patients are comfortable.

Kipling recommends finding health-care providers that have trans and queer-inclusive practices, including the following:

• Accessible policies around name changes
• Proper pronouns usage
• Gender inclusive restrooms
• Staff that are trained around gender-affirming care, weight stigma, anti-racism, and internalized bias

Kipling says this support should be extended to all patients, not just those who disclose their LGBTQ+ identities. Additionally, training around these practices should never be “one and done,” but rather, ongoing to ensure best practices are in place.

And if you find a doctor you are comfortable with, but don’t see many inclusive practices in place at their office? Advocating for these changes, and discussing the importance of affirming health-care settings for the LGBTQ+ community, is a helpful start (as long as you feel safe enough to speak up, of course).

When to seek support

Sometimes, it’s difficult to see when body image issues have taken over. They can be subtle, and flow into multiple different areas of your life. This is why it’s important to know the signs of more serious body image issues—whether you’re a member of the LGBTQ+ community or not—and when to reach out for support.

Rosenkrantz says if any of the following apply to you, it’s time to seek professional help:

• Spending a lot of thinking about your weight, shape, or appearance
• Feeling shame or embarrassment regarding your appearance, to the point where these feelings define your relationship with your body
• Frequently comparing yourself to others
• Increased mental health challenges, including depression, anxiety, substance use, or feeling helpless in controlling your body
• Feeling like you need to compensate for your body or eating by dieting, skipping meals, fasting, smoking cigarettes, vomiting or taking laxatives, or over-exercising

“Based on my work in my own practice, I can tell you that LGBTQ+ affirming therapy is a great tool to get support for body image issues and support for gender affirmation,” says Rosenkrantz. “If you are struggling with body image, know that you are loved, that you are not alone, and that there is hope for a life where you can find peace with your body.”