Zachary A. Soulliard

Sexual minority men (SMM) experience high rates of disordered eating, potentially related to stressors stemming from within the SMM community. The present cross-sectional study examined associations among intraminority gay community stress, body image, and community connectedness in relation to disordered eating (i.e., binge eating, purging, restricting, excessive exercise, and muscle building). A total of 314 SMM (Mage = 34.56, SDage = 8.13) were recruited via Qualtrics Survey Panel between May and June 2024. Participants completed the Eating Pathology Symptoms Inventory, Gay Community Stress Scale, Appearance Evaluation and Appearance Orientation subscales of the Multidimensional Body-Self Relations Questionnaire, and Connectedness to the LGBT Community Scale. The associations between gay community stress and disordered eating were examined via partial correlations. Three-way interaction terms (i.e., gay community stress*appearance evaluation*SMM community connectedness; gay community stress*appearance orientation*SMM community connectedness) were tested in moderated-moderation analyses to assess interactive effects on disordered eating. Greater gay community stress was associated with higher levels of disordered eating even when controlling for body image variables, SMM community connectedness, race, relationship status, and perceived weight status. High appearance evaluation buffered the association between gay community stress and binge eating in the presence of high community connectedness. Low community connectedness amplified the effect of gay community stress and high appearance orientation on excessive exercise and muscle building. Findings suggest a sense of belongingness may mitigate the effects of gay community stress and body image concerns on disordered eating. Results highlight the role of intraminority stressors faced by SMM. Both intraminority stressors and group-level resilience factors (e.g., community connectedness) warrant further consideration in eating disorder research and clinical interventions with SMM. Sexual minority men (SMM), including gay, bisexual, and queer men, experience higher rates of disordered eating than heterosexual men. In this study, we examined how stress related to the mainstream gay community, such as pressure to attain a specific body type or social status, is linked to disordered eating behaviors like binge eating, purging, food restriction, excessive exercise, and muscle building. We found that greater perceived gay community stress was associated with higher levels of disordered eating. However, feeling connected to other SMM helped protect against some of these effects. Specifically, those with high body satisfaction and strong community ties with other SMM were less likely to binge eat even when perceiving gay community stress. In contrast, those who placed a high importance on appearance but lacked community support were more likely to engage in excessive exercise and muscle building. These findings highlight both risk and protective factors within the SMM community. While certain pressures may contribute to body image concerns and disordered eating, fostering a sense of belonging and support among SMM may help reduce these risks.

As sex workers increasingly seek clients online, and exclusively online sex work (e.g., sexual content creation) expands in popularity, it is crucial to understand and address online sex workers’ occupational health concerns. There is a particular need for research with marginalized online sex workers, including transgender/nonbinary (TNB) people. Accordingly, we conducted semi-structured interviews with 14 U.S.-based TNB young adults, ages 22-30 years, who had done online sex work. We triangulated interview data through focus groups with 17 clinicians and advocates. Using template-style thematic analysis, we developed themes addressing reasons for doing online sex work (five themes); stressful dynamics (six themes); fulfilling dynamics (five themes); and protective factors (two themes). Participants did online sex work for a mix of financial and personal reasons. Stressful dynamics included pressure to conform to sexual stereotypes, restrictive platform rules, and sex work stigma. Fulfilling dynamics included skill/career development, self-exploration, and opportunities to promote healthier sexual norms. Economic stability and longer-term sex work experience emerged as protective factors. Clinicians and advocates should recognize the diversity of TNB young adults’ online sex work experiences, oppose restrictive laws and platform policies, and advocate for safety net programs that help young adults maintain economic stability.

LGBTQ-affirmative cognitive-behavioral therapy (CBT) is an evidence-based treatment for reducing transdiagnostic mental and behavioral health concerns among LGBTQ individuals. Preserving the effects of this intervention as it is translated into practice can maximize public health benefits. This study systematically identifies and evaluates implementation strategies for LGBTQ-affirmative CBT. First, we identified and operationalized implementation strategies used across five trials of LGBTQ-affirmative CBT using the Pragmatic Implementation Reporting Tool. Second, we evaluated the relative importance of these strategies via a quantitative assessment (N = 31 unique trial implementers). Survey responses were analyzed descriptively within each trial. Across all trials, we organized strategies as (1) high priority, (2) moderate priority, and (3) optional (if resources are available) for implementing LGBTQ-affirmative CBT. Within each trial, we identified 20 or more implementation strategies that were used, many of which overlapped across trials. We identified nine high priority strategies (e.g., working with clients to engage them in LGBTQ-affirmative CBT), nine moderate priority strategies (e.g., conducting ongoing training in LGBTQ-affirmative CBT), and nine optional/resource dependent strategies (e.g., showing visual indicators of LGBTQ affirmation within the physical spaces where LGBTQ-affirmative CBT is delivered). LGBTQ-affirmative CBT is a complex intervention requiring a package of implementation strategies. Our findings provide guidance for implementers in settings with different levels of resources regarding the highest priority strategies that may be needed to preserve the effectiveness of LGBTQ-affirmative CBT as it is translated into real-world settings.

Studies exploring disordered eating among transgender and nonbinary populations have primarily focused on minority stressors with a dearth of research examining the role of gender identity pride on body appreciation and intuitive eating. To address this gap in the literature, the present study, comprised of 148 transgender and nonbinary adults (M_age = 24.68, SD = 6.64), tested the associations among gender identity pride, body appreciation, and intuitive eating, controlling for demographics and minority stress variables. The study also tested body appreciation as a mediator in the cross-sectional association between gender identity pride and intuitive eating. Regression models indicated that greater gender identity pride was significantly associated with greater body appreciation, but not intuitive eating. Greater body appreciation was a significant mediator in the positive association between gender identity pride and intuitive eating. Findings support the significant role and relevance of examining gender identity pride as related to body appreciation and intuitive eating. Future research may determine the causal impact of gender identity pride on body image and eating behaviors in transgender and nonbinary populations. Clinicians may consider the positive role of gender identity pride when addressing body image and eating behaviors with their transgender and nonbinary clients.

Purpose: Transgender and nonbinary (TNB) populations experience disproportionate rates of sexual assault. Despite evidence from cisgender samples linking sexual assault exposure to body image concerns and disordered eating behaviors, such as weight and shape control behaviors (WSCBs), little is known about these relationships in TNB people. The purpose of this study was to assess associations among past-year sexual assault exposure, body areas satisfaction, body weight esteem, and high-risk WSCBs in a sample of TNB young adults. Methods: A sample of 714 participants completed a cross-sectional online survey. Multivariable linear and logistic models were fit to determine associations between constructs of interest. Natural effects mediation analyses assessed for potential mediation of the relationship between sexual assault and WSCBs by body areas satisfaction and body weight esteem. Analyses were stratified by three gender identity categories. Results: Past-year sexual assault exposure was associated with significantly decreased body areas satisfaction, but only for nonbinary participants. No significant association was found between sexual assault and body weight esteem. Sexual assault was associated with significantly increased risk for WSCBs across gender identity categories. No mediation of these relationships by body areas satisfaction and body weight esteem was observed. Conclusion: Findings support clinical consideration of WSCBs in TNB survivors of sexual assault. Results suggest that multiple factors, including body image and sexual assault, may contribute separately to disordered eating behaviors in TNB young adults.

Although intraminority gay-community stress has been theorized to affect sexual-minority men’s body dissatisfaction, this association has not been evaluated quantitatively. Using two samples of sexual-minority men—one sample recruited from a population-based study of U.S. adults ( N = 424; age: M = 54.29 years) and the other a sample meeting diagnostic criteria for depressive, anxiety, or trauma-/stressor-related disorders ( N = 251; age: M = 26.52 years)—in this study, we investigated associations between gay-community stress and body dissatisfaction. In both samples, gay-community stress was significantly associated with sexual-minority men’s greater body dissatisfaction in models that controlled for demographic and minority-stress variables. In terms of specific domains of gay-community stress, perceptions of the gay community’s focus on sex, social status, and social competition were significant correlates of greater body dissatisfaction. Future research can determine the impact of routinely addressing gay-community stress in body image and eating-disorder treatments for this population.

: Purpose: We extended the focus on body image research beyond cisgender, White sexual minority men (SMM) by describing body image concerns among Black and Latinx SMM and transgender/gender nonconforming (TGNC) adults and by examining protective effects of community connection. Methods: From 2016 to 2020, 447 Black and Latinx SMM (94%) and TGNC (6%) individuals in Los Angeles provided data semiannually. Participant endorsement of any body image concerns was determined by five body image codes (weight, fitness, appearance, body area dissatisfaction, and general body image) applied to participants' open-ended lists of health and body concerns. Fixed effects multivariable logistic regression was performed to examine the association between gay and racial/ethnic community connection and odds of any body image concerns, accounting for multiple records per person. An interaction term between gay and racial/ethnic community connection approximated the protective effect of connection to multiple, intersecting communities. Results: The majority of participants (51%) reported a body image concern, most commonly weight concerns, at least once across three years. Body image concerns were more common among Latinx participants ( χ ² = 17.79, p < 0.001) and participants experiencing food insecurity ( χ ² = 4.11, p = 0.04) and unmet basic financial needs ( χ ² = 10.56, p = 0.001). Gay community connection was protective against body image concerns, but only for participants who had high racial/ethnic community connection (adjusted odds ratio = 0.87, p = 0.05). Conclusion: Body image concerns were notable, especially among those with low community connection and higher socioeconomic burden. These findings suggest that building connections within SMM/TGNC and racial/ethnic communities may aid in building a support network that buffers against body image concerns.