Targeting Minority Stressors to Improve Eating Disorder Symptoms in Sexual Minority Individuals with Eating Disorders

Modified Project Summary/Abstract Section Eating disorders are one of the deadliest psychiatric disorders and are associated with high economic burden and numerous physical health consequences. One group at significantly increased risk for eating disorders is sexual minority (SM) individuals. Indeed, nationally representative data in the United States supports that SM adults have a 2-3-fold increased risk of developing an eating disorder compared to their non-SM peers. Critically, these mental health disparities have persisted during the past decade, with no signs of attenuating, making SM individuals one of the highest-risk groups for eating disorders. Risk is elevated in SM individuals due to chronic stressors and subsequent SM stress reactions (e.g., internalized stigma, low SM-stress coping self-efficacy). While SM individuals are seeking eating disorder treatment at increasing rates compared to non-SM peers, current treatments do not incorporate distinct SM identity-related stress processes that increase and maintain eating disorder symptoms in SM individuals. Further, SM individuals are more likely to drop out of existing eating disorder treatments compared to their non-SM peers. This suggests that identity-affirming treatments that address the unique needs of SM individuals with eating disorders could reduce barriers to treatment and treatment dropout in a vulnerable group. Given this crucial gap in the literature, the proposed study will refine and test an innovative virtually delivered treatment that integrates evidence-based care for eating disorders with SM-affirmative treatment (Promoting Resilience to Improve Disordered Eating; PRIDE) designed to target distinct identity-related stress processes (e.g., reductions in internalized stigma and increases in SM-stress coping self-efficacy) that theoretically underlie increased risk for eating disorders in SM individuals. If PRIDE displays a clinically meaningful effect on the purported targets (i.e., reduction in internalized stigma and increases in SM-stress coping self-efficacy) through 6-month follow-up during the open-phase trial (R61 phase; n = 30) and is feasible and acceptable, we will subsequently move to the R33 phase. In the R33 phase, we will conduct a pilot randomized controlled trial in 160 SM adults with eating disorders comparing PRIDE to supportive treatment to assess preliminary efficacy through 12-month follow-up. During the randomized controlled trial, we will also evaluate the mechanisms of action of the PRIDE treatment (e.g., reductions in internalized stigma and increases in SM-stress coping self-efficacy) through longitudinal analysis. The proposed project has substantial public health significance as SM adults are one of the most vulnerable groups for eating disorders. Given the virtual nature of PRIDE, this treatment has a high potential for wide dissemination and to reduce the public health impact of eating disorders in a vulnerable group.