Content note: This post discusses eating disorders and suicide risk in clinical terms. It is intended as an educational resource for healthcare providers. If you or someone you know is in crisis, please contact the 988 Suicide and Crisis Lifeline by calling or texting 988.
What the Research Shows
Eating disorders and suicide risk are being shown in research to be deeply interconnected. That intersection becomes significantly more dangerous in LGBTQIA+ populations shown in a 2026 study published in Clinical Nutrition ESPEN. The prevalence of high suicide risk more than triples compared to non-LGBTQIA+ students with no eating disorder symptoms when eating disorder risk and LGBTQIA+ identity co-occur in university students (Flôres et al., 2026).
This research carries direct clinical implications for any provider who works with young adults in healthcare, mental health, or academic settings.
Flôres et al. (2026) conducted a cross-sectional survey of 2,831 undergraduate students across 28 Brazilian federal universities, using validated screening tools to assess eating disorder risk. The eating disorder screening tools used were the Eating Attitudes Test-26 (EAT-26; Garner et al., 1982) and the Bulimic Investigatory Test of Edinburgh (BITE; Henderson & Freeman, 1987). Suicide risk was assessed using the Mini International Neuropsychiatric Interview, Module C (MINI-C; Lecrubier et al., 2002). Nearly half the sample (49.6%) identified as LGBTQIA+, making this one of the largest studies examining these co-occurring risks in a college population.
Eating disorder risk was high across the full sample. Nearly 29% of students screened positive for eating disorder risk on the EAT-26, and 22.5% showed highly disordered eating patterns including binge eating on the BITE (Flôres et al., 2026).
Suicide risk was alarmingly prevalent. More than half of participants (58.2%) showed some level of suicide risk, and 29% met criteria for high suicide risk on the MINI-C (Flôres et al., 2026). This is substantially higher than national survey data from Brazil that documented an increase in suicidal thoughts among undergraduates from 4.1% in 2014 to 8.5% in 2018 (ANDIFES, 2019) and represents a serious public health signal.
LGBTQIA+ students faced compounded risk. After adjusting for age, race/skin color, and family income, LGBTQIA+ students were nearly twice as likely to have high suicide risk compared to non-LGBTQIA+ peers. Students who reported questioning their gender identity or sexual orientation also faced significantly elevated risk.
Eating disorder risk dramatically amplified suicide risk, especially for LGBTQIA+ students. This is the most clinically significant finding. LGBTQIA+ students who also screened positive for eating disorder risk were more than 3.5 times as likely to have high suicide risk compared to non-LGBTQIA+ students with no eating disorder symptoms (Flôres et al., 2026). This is consistent with findings from a large U.S. national study showing that sexual minority students with a positive eating disorder screen are between 3.6 and 5.6 times more likely to report suicidal ideation and past-year suicide attempts than heterosexual peers (Lipson & Sonneville, 2020).
Why These Risks Compound
The mechanisms linking eating disorders, LGBTQIA+ identity, and suicide risk are structural and psychological.
The minority stress model explains that chronic exposure to stigma, discrimination, and invalidation related to sexual orientation or gender identity creates a persistent psychological burden (Cardoso et al., 2022). This chronic stress is a documented risk factor for both eating disorder development and suicidal ideation. Sexual and gender minority individuals face greater vulnerability across a range of mental health outcomes compared to their heterosexual and cisgender peers (Gilmour, 2019; Horwitz et al., 2020). Additionally, the college years can be a high-risk time due to identity formation, increased independence, and frequent social changes.
Eating disorders themselves are independently associated with high suicide risk. The American Psychiatric Association (2013) specifically highlights the importance of assessing for suicidal ideation and behaviors in individuals with anorexia nervosa or bulimia nervosa. When these factors layer onto the elevated baseline risk already present in LGBTQIA+ students, the cumulative effect is precisely what Flôres et al. (2026) documented.
What This Means for Clinical Practice
1. Eating disorder screening and suicide risk assessment must be integrated
Providers who screen for eating disorders should also assess for suicide risk to gain the full clinical picture, especially in LGBTQIA+ patients. The reverse is equally true. Elevated suicide risk should prompt inquiry about eating and body image concerns.
The American Psychiatric Association’s (2013) DSM-5 explicitly recommends that suicide ideation and behaviors should be specifically assessed in patients with anorexia nervosa or bulimia nervosa. A single eating disorder symptom can increase the odds of suicidal ideation by up to 70%, while the presence of five or more symptoms increases the likelihood of past-year suicide attempt more than elevenfold in university students (Lipson & Sonneville, 2017).
2. LGBTQIA+ identity is a clinically relevant risk factor that deserves explicit attention
Providers should be equipped to:
- Create a clinical environment where LGBTQIA+ patients feel safe disclosing their identity
- Understand how minority stress contributes to both eating disorder vulnerability and suicide risk (Cardoso et al., 2022)
- Adjust screening frequency and intervention thresholds accordingly
3. University and student health settings are a critical intervention point
The college years represent both a high-risk period and a high-opportunity window. Students are accessible and at an age where intervention can meaningfully alter long-term trajectories.
Providers working in student health, university counseling, and campus nutrition services are uniquely positioned to identify co-occurring eating disorder and suicide risk early. That requires training. Clinicians should be familiar with validated screening tools, LGBTQIA+-affirming care, and the clinical judgment to act when risks are present.
4. “Questioning” identity carries significant risk, too
Students who reported questioning their gender identity or sexual orientation showed elevated eating disorder and suicide risk at rates comparable to those who clearly identified as LGBTQIA+ (Flôres et al., 2026). Students in this liminal space may be less visible to providers, less connected to community support, and less likely to self-identify when disclosures about sexuality or gender feel uncertain.
Providers should not assume that because a patient hasn’t named their identity, the associated risks don’t apply.
5. These are learnable clinical skills
Providers sometimes avoid asking about eating behaviors, sexual orientation, gender identity, or suicide risk out of fear of saying the wrong thing or making a situation worse. The research does not support avoidance. Asking with warmth, without judgment, and with the skills to follow through, is among the most impactful things a provider can do.
Training in eating disorder-informed care, LGBTQIA+-affirming practice, and basic suicide risk assessment is not specialist territory. It is foundational clinical competence for anyone working with young adults.
How EDPEN Can Help
EDPEN offers interdisciplinary training for medical, mental health, nutrition, and recovery providers that are rooted in evidence-based, trauma-informed, and culturally sensitive approaches. Our programs equip providers with the skills to recognize eating disorder risk across diverse populations, have confident clinical conversations, and coordinate care effectively.
If the findings in this article are relevant to the patients you serve, we’d love to have you in our next training.
Learn more about EDPEN’s programs at edpen.org →
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787
Associação Nacional dos Dirigentes das Instituições de Ensino Superior (ANDIFES). (2019). V Pesquisa nacional de perfil socioeconômico e cultural dos graduandos das IFES – 2018. https://www.andifes.org.br/wp-content/uploads/2019/05/V-Pesquisa-Nacional-de-Perfil-Socioeconomico-e-Cultural-dos-as-Graduandos-as-das-IFES-2018.pdf
Bodell, L. P., Cheng, Y., & Wildes, J. E. (2019). Psychological impairment as a predictor of suicide ideation in individuals with anorexia nervosa. Suicide and Life-Threatening Behavior, 49(2), 520–528. https://doi.org/10.1111/sltb.12460
Cardoso, B. L. A., Paim, K., Catelan, R. F., & Liebross, E. H. (2022). Minority stress and the inner critic/oppressive sociocultural schema mode among sexual and gender minorities. Current Psychology, 30, 1–9. https://doi.org/10.1007/s12144-022-03022-0
Clark, K. A., Salway, T., McConocha, E. M., & Pachankis, J. E. (2022). How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts. SSM – Qualitative Research in Health, 2, Article 100044. https://doi.org/10.1016/j.ssmqr.2022.100044
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003
Flôres, L. S., da Silva Júnior, A. E., da Silva Guedes, G., Cerqueira Rocha, M. V., Pereira, M. R., & Bezerra Bueno, N. (2026). Eating disorders risk potentiates high suicide risk in LGBTQIA+ university students. Clinical Nutrition ESPEN. https://doi.org/10.1016/j.clnesp.2026.102963
Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12(4), 871–878. https://doi.org/10.1017/S0033291700049163
Gilmour, H. (2019). Sexual orientation and complete mental health. Health Reports, 30(11), 3–10. https://doi.org/10.25318/82-003-x201901100001-eng
Henderson, M., & Freeman, C. P. (1987). A self-rating scale for bulimia: The ‘BITE’. British Journal of Psychiatry, 150(1), 18–24. https://doi.org/10.1192/bjp.150.1.18
Horwitz, A. G., Berona, J., Busby, D. R., Eisenberg, D., Zheng, K., & Pistorello, J. (2020). Variation in suicide risk among subgroups of sexual and gender minority college students. Suicide and Life-Threatening Behavior, 50(5), 1041–1053. https://doi.org/10.1111/sltb.12637Lecrubier, Y., Weiller, T., Hergueta, P., Amorim, P., Bonora, L. I., & Lépine, J. P. (2002). MINI: Mini international neuropsychiatric interview — Brazilian version 5.0.0. http://www.cosemssp.org.br/downloads/Cursos/Saude-Mental-DSM-07-03.pdf
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