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Eating Disorders

(PS6-A3) Clinical Characteristics and Preliminary Mental Health Outcomes for Sexual Minority Patients in a Remote Higher Level of Care Eating Disorder Treatment Program

Friday, November 17, 2023
4:00 PM – 5:00 PM PST
Location: Regency Ballroom, Level 7
Data show that sexual minorities (SM) are at heightened risk for eating disorders (ED) compared to their heterosexual counterparts. Elevated levels of other psychiatric concerns, including mood and anxiety symptoms along with suicidality, have been found in SM populations. Minority stress models posit that negative mental health consequences may be the result of stigma experienced by SMs. Compounding these disparities is the fact that SMs remain underserved and underrepresented in ED treatment and research. Few studies have compared SM and heterosexual patients in clinical settings. This naturalistic observational study addressed this gap via retrospective chart review of clinical characteristics and preliminary outcomes for SM and heterosexual patients admitted to a remote ED treatment program. The treatment program offers personalized, patient-centered care, including specialty groups based on sexual identity. All patients receive individual and group-based cognitive-behavioral therapies as a core component of treatment. Clinical staff are trained in culturally-competent, affirming approaches for working with the SM population. Patients (N = 193; SM = 26.5%, heterosexual = 73.1%), who largely identified as White (87.6%) women (91.7%), completed symptom measures (eating disorder, depression, anxiety) at admission, monthly, and at discharge. There were no significant differences in baseline ED symptoms; however, SM patients had significantly higher depression and anxiety symptoms at admission. SM patients were also significantly younger as well as more likely to be diagnosed with a comorbid mood disorder, have elevated suicide risk, and be admitted to the PHP level of care. Linear mixed-effects models with Bonferroni-correction were used to examine outcomes across sexual identities through up to 6 months of treatment. Significant main effects of time were identified with ED, depressive, and anxiety symptoms all decreasing. Average global ED and depressive symptoms dropped below clinical threshold levels for both SM and heterosexual patients, indicating at least partial remission. There were no significant interactions between sexual identity and time for any symptom measures, indicating that trajectories did not differ. This study provides preliminary evidence of the effectiveness of inclusive, remote ED treatment employing cognitive-behavioral therapies for SMs. Contrary to prior research, this study found elevated depressive and anxiety symptoms but not ED symptoms for SM patients. The breadth of sexual identities reported in this sample precluded subgroup analyses; aggregation into a single SM category may have masked differences. Additionally, prior research demonstrates that the operationalization and assessment of sexual identity may influence findings. Future research should examine more diverse samples (e.g., race, gender), applying an intersectional lens to explore risk profiles and treatment response across marginalized identities. Furthermore, future investigations should isolate aspects of treatment that are most beneficial for SMs to further inform the adoption and/or adaptation of existing treatment protocols as well as the development of culturally-specific interventions.
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