Bodies under stress—a psychological parallel mediation model between daily LGBTQ + heterosexism and eating disorder risk

Purpose: LGBTQ + people have shown health disparities compared to heterosexual and cisgender people in eating disorders. How these disparities are determined, however, is an understudied area. Through the use of a psychological mediation framework, this study aims to explore how daily heterosexist experiences related to one's LGBTQ + identity may determine eating disorder risk. Methods: 376 LGBTQ + people from Italy responded to self-report questionnaires regarding daily heterosexist experiences, eating behaviors and associated factors in an online anonymous survey. Descriptive, bivariate and mediation analyses were conducted using the "PROCESS" macro, including distress scores for heterosexist experiences, emotion dysregulation, self-esteem, shame, and eating disorder risk, controlling for body-mass index, age and socioeconomic status. Results: Statistically significant positive associations were found between distress related to heterosexist experiences, emotion dysregulation, shame and eating disorder risk. Mediation analyses found that the direct effect of heterosexist experiences on eating disorder risk was nonsignificant. The indirect effects of heterosexist experiences on eating disorder risk through emotion dysregulation (B = 0.041, β = 0.304, BootSE = 0.017, 95% CI [0.006, 0.078]) and low self-esteem (B = 0.092, β = 0.089, BootSE = 0.023, 95% CI [0.049, 0.145]) were significant. The indirect effect through shame was nonsignificant. Conclusions: Heterosexist experiences seem to have significant indirect effects on eating disorder risk through emotion dysregulation and low self-esteem. Policies for reducing harassment, discrimination and violence related to sexual orientation and gender identity in institutional, organizational and social contexts may help prevent negative health outcomes in LGBT + people. Clinical contexts may benefit from considering the effects of minority stress. Level of evidence: Level 3-Observational cross-sectional study.