PROJECT SUMMARY/ABSTRACT
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; e.g., gay, lesbian, bisexual, non-heterosexual) individuals. Indeed, nationally
representative data in the United States supports that SM adults of all genders have a 2-3-fold increased risk
of developing an eating disorder compared to their non-SM peers. Critically, these disparities have persisted
during the past decade, with no signs of attenuating, making SM individuals one of the most high-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) related to being a marginalized group.
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.
