Sexual and gender minority individuals report higher rates of lifetime traumas and current PTSD than cisgender heterosexual individuals admitted to residential eating disorder treatment

Eat Weight Disord. 2022 Mar;27(2):813-820. doi: 10.1007/s40519-021-01222-4. Epub 2021 May 31.


Objective: Trauma and posttraumatic stress disorder (PTSD) are associated with eating disorders (EDs), which occur across all sexual orientations and gender identities. Prior traumas and PTSD also are reported to occur significantly more frequently in individuals identifying as lesbian, gay, bisexual, transgender, queer or questioning, non-binary, or other (LGBTQ+), but little is known about rates of PTSD in LGBTQ+ individuals with EDs admitted to residential treatment (RT).

Method: Our sample included 542 adults with DSM-5 EDs admitted to RT at seven sites in the U.S. Rates of current presumptive PTSD (PTSD +) by LGBTQ + status were determined by responses on the Life Events Checklist (LEC-5) and the PTSD Symptom Checklist for DSM-5 (PCL-5).

Results: Nearly 24% of admitting individuals self-reported as LGBTQ+, and these individuals had significantly higher LEC-5 total scores (5.6 v. 4.9), PCL-5 total scores (41.9 v. 34.0), and rates of PTSD+ (63% v. 45%) than non-LGBTQ+ individuals. The LGBTQ+ with PTSD+ group reported (1) significantly more unwanted sexual experiences, sexual assaults, physical assaults, and severe human suffering experiences, and (2) significantly greater ED, depressive and trait-anxiety symptoms than the non-LGBTQ+ group with PTSD+.

Conclusions: LGBTQ+ individuals had significantly higher rates of high impact lifetime traumas and presumptive PTSD+, as well as greater ED and comorbid symptom severity, than non-LGBTQ+ individuals. Development, implementation and assessment of integrated treatment protocols for LGBTQ+ individuals with an ED and PTSD+ is warranted to address the needs of this underserved and often overlooked population.

Level of evidence: Level III: Evidence obtained from cohort or case-control analytic studies.

Keywords: Eating disorders; LGBTQ+; Posttraumatic stress disorder; Residential treatment; Severity; Sexual and gender minorities.

MeSH terms

  • Adult
  • Feeding and Eating Disorders* / epidemiology
  • Feeding and Eating Disorders* / therapy
  • Female
  • Heterosexuality
  • Humans
  • Residential Treatment
  • Sexual and Gender Minorities*
  • Stress Disorders, Post-Traumatic* / epidemiology
  • Stress Disorders, Post-Traumatic* / therapy