The role of LGBT+ heterosexist experiences about gender expression in binge eating: a psychological mediation model

Introduction: Minority stress has been found to be consistently associated with disordered eating behaviours, including binge eating. Heterosexist Experiences About Gender Expression (HEAGE) – in which people experience discrimination, harassment, invisibility and feelings of exclusion related to how they express their gender identity – have been found to be associated with negative mental health outcomes. Objectives and methods: This study aims to explore how HEAGE may affect binge eating. A cross-sectional online anonymous survey was conducted involving 372 self-identified LGBT+ people from Italy. Self-report questionnaires were administered regarding distress related to heterosexist experiences, binge eating and associated factors. Descriptive and bivariate analyses were conducted. Mediation analyses were conducted through the “PROCESS” macro including HEAGE, emotion dysregulation, low self-esteem, body shame and binge eating, controlling for age, body-mass index and socioeconomic status. Results: Statistically significant positive associations were found between all the main study variables. Mediation analyses (R² = .702) found that the direct effect of HEAGE on binge eating was nonsignificant (95% CI [-.047, .330]). The indirect effects of HEAGE on binge eating through emotion dysregulation (B = .06, BootSE = .030, 95% CI [.015, .132]), body shame (B = .136, BootSE = .040, 95% CI [.055, .215]) and low self-esteem (B = .054, BootSE = .040, 95% CI [.055,. 215]) were all significant. Conclusions: HEAGE seem to have a small significant effect on binge eating through emotion dysregulation, body shame and low self-esteem. Exposure to HEAGE in day-to-day life may reduce availability of psychological coping resources for LGBT+ people, heightening the risk of dysfunctional coping behaviours such as binge eating. Policies for reducing heterosexist experiences related to sexual orientation and gender identity in institutional, organizational and social contexts are needed which may help prevent negative health outcomes. Clinical contexts may benefit from considering the effect of minority stress on intrapsychic processes.