'I didn't want a feminine body': Calls for eating disorder services to better support LGBTIQ+ patients
This article contains references to eating disorders.
Anna Rose's journey with disordered eating began at 20, when a simple desire to become more fit and healthy developed into a pattern of restrictive eating.
It continued for 13 years.
"It started like many people, with wanting to get into shape and exercise, and it was at a really big transition point in my life," Anna told SBS News.
"It snowballed into becoming very, very rigid around exercise initially, and restrictive around eating, but I didn't really have insight into what was going on for a long time. I just thought I was doing the things I was meant to (in order to) stay healthy and well."
At the time, Anna did not know they were neurodivergent, queer and non-binary
It wasn't until three years ago that they made the connection, and realised how their gender identity had contributed to their eating disorder.
"I always felt like I didn't want to be in a more feminine body, so I didn't miss having curves, or having my period and things like that, and I didn't understand why people were concerned about that," they said.
"I lost my period for the best part of 10 years, but I had no concern over that until I needed to put on weight to be able to have kids."
While Anna, now 41, considers themselves recovered, they say it took years to understand their gender identity and eating disorder.
They believe this was partially due to a lack of understanding combined with a need for eating disorder services to be more inclusive to adequately support the needs of queer and gender-diverse patients.
"There is a really clear need for more inclusive eating disorder care that acknowledges the variable role that an individual's experience with gender and sexuality can play on their eating disorder or body image concerns," Anna said.
"For patients who identify as gender diverse ... their experiences in accessing care have not been affirming of their gender identity and they haven’t really been able to address the factors that are relevant.
"We certainly need a lot more work in that area."
Anna is not alone in their experience.
According to clinical psychologist Dr Jane Miskovic-Wheatley, international research has indicated people within the LGBTIQ+ community may be at an increased risk of body image and eating concerns.
She says people within these communities may also have difficulty accessing treatment or diagnoses.
"We have found in clinical practice and emerging research that there is a higher proportion of people in the LGBTIQ+ community that do have an experience of body image concern, excessive exercise, eating restrictions, binge eating," she said.
"But often people don't present to services because they don't necessarily feel welcome or understood, and also maybe presentations are different from what we might expect."
Dr Miskovic-Wheatley is leading the IncludED Study, the first Australian LGBTIQ+ community-wide survey designed to build an understanding of disordered eating and eating disorder diagnoses.
The study, which is run by Inside Out Institute for Eating Disorders, was launched on Sunday at Mardi Gras Fair Day alongside the EveryBODY Welcome campaign, with seven national eating disorder organisations coming together to discuss and promote inclusive care and services for eating disorders and body image issues.
Dr Miskovic-Wheatley says the health system needs to be more open-minded in perceptions of how eating disorders can present.
"We are doing a disservice to the community if we are not being open-minded about what [eating disorders] might look like," she said.
"If we aren't open-minded, people aren't going to come forward to get help and support if they need it."
WorldPride 2023 coincides with the 50th anniversary of the first Australian Gay Pride Week, the 45th anniversary of the Mardi Gras Parade and fifth anniversary of the Australian marriage equality plebiscite.
LGBTIQ+ Australians seeking support with mental health can contact QLife on 1800 184 527 or visit qlife.org.au
ReachOut.comalso has a list of support services.
Intersex Australians seeking support can visit Intersex Peer Support Australia at isupport.org.au
Readers seeking support for eating disorders and body image concerns can contact Butterfly Foundation on 1800 33 4673. More information is available at butterfly.org.au