Reasons Eating Disorder Center puts a strong emphasis on creating an eating disorder treatment environment that feels safe, inclusive and effective for all. We are passionate about and committed to creating access to treatment for marginalized communities. With that in mind, we are thrilled to announce our blog collaboration with Jamie (OJ) Bushell of thirdwheelED. OJ is a mental health and eating disorder recovery advocate, a writer and the co-creator of thirdwheelED. ThirdwheelED serves as a platform to increase visibility of how eating disorders impact the often-marginalized LGBTQIA+ community and creates space to participate in advocacy work through storytelling. OJ will be joining us on the Reasons blog from time to time to share their insights and perspective into eating disorder treatment and recovery within the LGBTQIA+ community. Please join us in welcoming OJ to the Reasons blog and read on for their perspective!

When I was in residential eating disorder treatment, during a group session, the therapist kept referring to our “boyfriends,” assuming that every client in the group was a heterosexual, cisgender female. While this is not an uncommon or unique experience, it’s an example of how current eating disorder discourse often excludes marginalized communities, including LGBTQIA+ folks. Experiences like this one, in which groups of people are left out of the conversation in a space that is supposed to be safe and healing for all, made it feel like there was no space for me in the group.

Accessing treatment already requires courage and is quite difficult due to financial and geographic barriers that are ubiquitously experienced for many suffering from eating disorders. Members of the LGBTQIA+ communities face a compounding barrier of finding treatment that is also inclusive and gender-affirming. Treatment can be harmful for underrepresented folks when they are mistreated by clinicians or other clients in the milieu. It’s important for folks to find eating disorder treatment that doesn’t just offer the facade of safety. Simply walking through the doors and accessing treatment isn’t enough.

Clinicians need to be aware of the role marginalization has played in their client’s life along with the trauma associated with marginalization. It is critical to ensure that this type of trauma does not reoccur in the eating disorder treatment setting. There are a number of action steps clinicians can take to make a safer, or braver, space for your clients.

  1. Learn about and explore your own biases regarding sexuality and gender. Like all humans, you embody your own intersectional identities that comprise elements of both privilege and oppression. Just like your client, your identity is nuanced. Even though there are potentially aspects of your clients’ lives or identities that you do not share or understand, you can take intentional steps to mitigate the impact of unintentional biases.
  2. Ask for and then proceed to use a client’s pronouns. Do not make an assumption of pronouns based on someone’s appearance or name. If you make a mistake, correct yourself, and move on. As an act of allyship, you may consider stating your pronouns on your website or in your email signature.
  3. Validate your client’s identity. Your client may be coming from a place where they don’t feel legitimate in their identity. This experience can really take a toll on one’s sense of self-worth and self-efficacy. Validate your client’s experience and identity in order to cultivate a relationship built on trust and understanding.
  4. Understand that a shared identity does not equate to a shared or similar experience between individuals. Just because two individuals are transgender and are struggling with an eating disorder does not mean their experiences, behaviors, and thoughts will be the same. Likewise, don’t assume that someone with a marginalized identity is struggling because of their identity. It’s helpful to ask how your client’s gender and/or sexuality (race, socioeconomic status, religion, size, ability, etc.) present, interact, or may relate to their eating disorder.
  5. Refrain from invasive questions about transitioning. Some people want gender affirmation surgery or hormone replacement therapy, but others don’t. For some individuals, transitioning doesn’t have an impact on their identity. An identity is valid regardless of steps taken (or not taken) to transition.
  6. Educate yourself on what it means to be transgender or gender non-conforming. Relying on your client to teach you about the transgender experience places the burden on your client. Read books, blogs, follow folks on social media, and seek supervision as needed. Make yourself vulnerable to learning that which you didn’t or don’t know.
  7. Remove gendered materials from your clinical repertoire. If you lead groups and use images in your materials that are overly gendered, consider replacing images. Be thoughtful around the images in your office that your client sees, even in the waiting room. Imagery makes an impact.
  8. Understand that the language you may use with a cisgender, heterosexual client around body image and self-acceptance may not resonate with a transgender or gender non-conforming client. For instance, rather than striving for body acceptance or body positivity, utilize language that is more compassionate and resonates, such as body neutrality, body liberation, or body respect.

Creating safer spaces can help mitigate the detrimental impact of prejudice and bias that LGBTQIA+ individuals face. Research has shown that increased acceptance and affirmation in spaces for LBGTQ youth can decrease the risk of suicide (The Trevor Project, 2020).

Remember, however, that the LGBTQIA+ community isn’t a monolith. What works for one transgender client, might not fit for another. The LGBTQIA+ community is diverse and complex. Communicating with clients around what feels safest to them is imperative.


The Trevor Project. (2020). LGBTQ & Gender-Affirming Spaces.