(PS7-23) Does Sexual and Gender Orientation Moderate the Effect of Posttraumatic Cognitions on Disordered Eating?

Sexual and gender minority (SGM) individuals generally report higher levels of psychological distress, including higher rates of posttraumatic stress disorder (PTSD) and disordered eating (DE), compared to their heterosexual and cisgender peers. This may be due to the sequelae of minority stress, leading to internalized rejection and shame related to their identity. A prominent symptom of PTSD is marked changes in thinking after the traumatic event, or posttraumatic cognitions (PTC), which can include negative evaluation of the self and increased sense of guilt and shame. Given that DE is a common comorbidity of PTSD, PTC may influence or exacerbate pre-existing maladaptive cognitions characteristic of DE, such as negative thoughts about one’s body and low self-esteem. Less is known about whether SGM individuals are uniquely affected by PTC, due to pre-existing stress and internalization associated with belonging to a marginalized community, and whether this may lead to higher rates of DE among SGM individuals following a traumatic experience.

To address this gap in the literature, we examined SGM status as a moderator of the relationship between PTC and DE in a national sample of recently separated post-9/11 Veterans who had experienced a Criterion A traumatic event (n=1084, 21.5% SGM, 78.5% heterosexual and cisgender). Participants self-reported their gender and sexual orientation and completed the Posttraumatic Cognitions Inventory (PTCI) and the Eating Disorder Examination Questionnaire (EDE-Q). SGM veterans included those identifying as gay, lesbian, bisexual, or something else other than straight, and/or any gender other than cisgender man or woman. Separate linear regression models were used to investigate the associations between each subscale of the PTCI (negative cognitions about self, negative cognitions about the world, and self-blame), SGM status, and their interaction on EDE-Q scores, while controlling for body mass index, age, educational status, and racial identity.

There were main effects of negative cognitions about self (B[SE]=.38 [.04]), negative cognitions about the world (B[SE]=.27 [.03]), as well as self-blame (B[SE]=.26 [.03]) on DE (ps< .001), such that higher scores on each subscale were associated with higher levels of DE. There was also a main effect of SGM status in each regression model (B[SE]s = .36-.48 [.13], ps< .01), with SGM veterans experiencing higher levels of DE relative to non-SGM veterans. There were no significant interaction effects. In stratified analyses, each PTCI subscale had a significant positive association with DE in both SGM (B[SE]s=.22-.42 [.08-.09], ps< .05) and non-SGM veterans (B[SE]s=.26-.38 [.03-.04], ps< .001), respectively.

Results suggest that both PTC and SGM identity are associated with DE, regardless of sexual orientation. Consistent with previous literature, we found that PTC were associated with forms of behavioral dysregulation, i.e., DE, among veterans with trauma histories. Given that SGM veterans remain understudied, future research is needed to explore the role of PTC in this population and to determine if other factors, such as experiences of discrimination, may explain higher levels of DE in SGM veterans.