The role of LGBT+ vicarious trauma in eating disorder risk – a psychological mediation model

Introduction: In scientific literature, minority stress appears to be consistently associated with a heightened risk of developing disordered eating behaviours and full-blown eating disorders. Among the various forms of minority stress, there is limited data investigating the role of witnessed heterosexist experiences (vicarious trauma), such as witnessing discrimination, harassment, unfair treatment or violence happening to other LGBT+ people. Objective and Methods: The present study aims to examine the association between witnessed heterosexist experiences and eating disorder risk by investigating the possible mediating role of emotional dysregulation, self-esteem and shame. An anonymous online survey was conducted involving 372 LGBT+ people from the Italian context. Participants completed self-report questionnaires regarding heterosexist experiences and factors associated with eating behaviour. Descriptive, bivariate, and mediation analyses were conducted through the “PROCESS” macro including all described main variables while controlling for body mass index, age, and socioeconomic status. Results: Distress related to vicarious trauma was relatively common in the participants (Raw score M = 24.7; Range = [6 – 30]; S.D. = 5.15). Statistically significant positive associations were found between all the main variables in bivariate analyses. Mediation analyses (R² = .428) highlighted a direct effect of vicarious trauma on eating disorder risk (B = .580, BootSE = .163, 95% CI [.259, .902]) and an indirect effect of vicarious trauma on eating disorder risk through low self-esteem (B = .117, BootSE = .162, 95% CI [.005, .332]) and emotion dysregulation (B = .079, BootSE = .041, 95% CI [.008, .171]). The indirect effect through shame was nonsignificant (95% CI [-.045, .174]). Conclusions: Witnessed heterosexist experiences appear to have a small but significant indirect effect on eating disorder risk through emotional dysregulation and low self-esteem. Health promotion contexts would benefit from policies at the institutional, organizational, and social levels to prevent minority stress and reduce observed health disparities.