Principles of LGBTQIA+ : Affirmative Therapy for Eating Disorders

On June 18th, Dr. Tiffany A. Brown, Assistant Professor in the Department of Psychological Sciences at Auburn University, and Co-Director of the Auburn Eating Disorders Clinic (AEDC), presented “LGBTQ+ Affirmative Therapy for Eating Disorders”.

Affirmative therapy doesn’t just accept someone’s identity - it centers and validates it. This approach helps LGBTQIA+ clients understand how systemic oppression has shaped their mental health, while also empowering them to reclaim their sense of self and community.

The 6 Core Principles of LGBTQIA+ Affirmative Therapy

The LGBTQIA+-Affirmative Adaptation Model includes six core principles:

1. Normalize responses to minority stress in LGBTQIA+ individuals

Help clients understand that symptoms of depression, anxiety, or disordered eating may be natural responses to persistent external stress, not personal failings.

2. Explore the impact of early and ongoing identity-related stress

Therapists should assess how experiences with rejection, stigma, and concealment have shaped cognitive patterns, and work with clients to rewrite disempowering narratives.

3. Empower clients to navigate the consequences of minority stress

Acknowledge that minority stress can limit life opportunities and support clients in developing coping strategies, identity pride, and self-efficacy.

4. Support authentic, safe relationships

Many LGBTQIA+ individuals report less social support and more rejection across relationships. Treatment should help clients build genuine, affirming connections, whether with family, chosen family, or the broader community.

5. Highlight strengths within LGBTQIA+ individuals and communities

Celebrate personal and collective resilience, from advocacy during the HIV/AIDS crisis to creative expression and social justice leadership. Recognize each client’s journey through identity development, coming out, and self-discovery.

6. Take an intersectional lens

LGBTQIA+ affirmative therapy acknowledges that identity is complex. Race, gender, class, religion, disability, and more intersect with LGBTQIA+ identity to shape both stress and resilience. Treatment must reflect this.

Promoting Resilience Through PRIDE: A Model of Eating Disorder Care for LGBTQIA+ Individuals

Promoting Resilience to Improve Disordered Eating (PRIDE), is a 14-week, virtual treatment program specifically designed for LGBTQIA+ individuals (Brown et al. 2024).

The PRIDE program integrates:

• Cognitive Behavioral Therapy (CBT) for eating disorders

• LGBTQIA+-affirmative therapeutic techniques

• A focus on minority stress and intersectionality

• Skills for emotion regulation, self-monitoring, and identity-based coping

Structure:

• Module 1 (sessions 1-2): Making Early Change, Connecting LGBTQIA+ Stress and Eating

• Module 2 (sessions 3-6): Beliefs around Eating, Food and Weight and Ties to LGBTQIA+ Stress

• Module 3 (sessions 5-9): Emotional Triggers and Links to LGBTQIA+ Stress

• Module 4 (sessions 9-13): Body image

• Module 5 (sessions 13-14): Relapse prevention

Outcomes:

Participants report improvements in body image, eating behaviors, and reduction in purging behaviors. The program also has a high retention rate and acceptability, with clients noting that the LGBTQIA+ focus helped them feel seen and understood.

Rethinking What Eating Disorder Recovery Looks Like for LGBTQIA+ Individuals

LGBTQIA+ individuals have always navigated a complex landscape of resilience and resistance. Eating disorder treatment for LGBTQIA+ individuals should honor that legacy by centering their stories, challenges, and strengths.

To do that, we must continue to:

• Train clinicians in LGBTQIA+-affirmative therapy

• Address systemic inequities in access to treatment

• Expand programs that incorporate minority stress theory

• Normalize the need for tailored support, not because LGBTQIA+ people are “broken,” but because the systems around them often are

Healing doesn’t require someone to change who they are. It requires an environment that affirms who they’ve always been.

On-Demand Option:

Were you unable to attend our June CE Webinar? You can now watch our expert-led training here.

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^Citations:  

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• ^{Badenes‑Ribera, L., Fabris, M. A., & Longobardi, C. (2018). The relationship between internalized homonegativity and body image concerns in sexual minority men: A meta‑analysis. Psychology & Sexuality, 9(3), 251–268. https://doi.org/10.1080/19419899.2018.1476905}  
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