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istorically, people have believed only cisgender women and teens struggle with eating disorders. But this is a common misconception that perpetuates bias and prevents people from getting the treatment they need. The trans and non-binary community, in particular, experiences high rates of eating disorders but is grossly underrepresented in research and treatment. 

Eating Disorder Prevalence in the Trans & Non-binary Community

Trans and non-binary individuals are disproportionately affected by mental health conditions, including eating disorders, compared to their cisgender peers. (1) However, we can only estimate prevalence rates at this point, because there simply hasn’t been enough research conducted specific to trans and non-binary individuals. Instead, studies often lump LGBTQ+ folks together, making it harder to focus on the unique struggles of the trans and gender-expansive community. (2) 

One study surveying nearly 300,000 U.S. college students revealed an elevated risk of eating disorder diagnoses, compensatory behaviors, and past-month laxative use among transgender students compared to their cisgender peers. In fact, nearly 16% of the trans students surveyed reported an eating disorder diagnosis within the last year. This figure is quite high considering only 1.85% of cisgender heterosexual women, 3.52% of cisgender queer women, 2.06% of cisgender queer men, and less than one percent of cisgender heterosexual men reported an eating disorder diagnosis. (3)

Trans students also reported higher rates of diet pill use, past-month vomiting, and laxative use. Over 13% of trans students surveyed reported diet pill use and 15% had used laxatives or vomited in the past month. None of the other demographics came close to these figures, with rates under 5.24% for past-month vomiting or laxative use among cisgender queer women and 5.11% for diet pill use among this same group. (3)

Why Do Trans & Non-binary Folks Experience Higher Rates of Eating Disorders Than Cis People?

This is a complex question with an equally complicated answer. Eating disorders are multi-faceted mental health conditions influenced by many risk factors, including genetic influences and environmental factors, through their effects on the individual, community, and cultural level. But professionals have come up with a few reasons that may explain the high rates of eating disorders among trans and non-binary people, including: (3)

  • Trans people may engage in disordered eating behaviors to accentuate desired physical features that are more in line with their gender identity.
  • They may also use these behaviors to attempt to suppress gendered features that cause gender dysphoria.
  • Trans women may aim to lose weight to try to achieve the “ideal” female body.
  • Trans women and men may attempt to lose weight to suppress secondary sexual characteristics.
  • Trans people experience minority stress due to stigma, discrimination, gender-based violence, and more. Minority stress has been linked with patterns of disordered eating, as well as poor mental health outcomes.
  • Trans people may also have a higher chance of receiving mental health care, since they are often required to attend therapy to receive gender-affirming care, such as hormone replacement therapy. If they are more likely to have contact with a provider, they may be more likely to receive a diagnosis (although this explanation likely only accounts for a small percentage of the disparity between trans and cis individuals).

Though not all trans people experience gender dysphoria, it has a powerful influence on eating disorders in the trans and non-binary community. Gender dysphoria refers to the psychological distress and anxiety caused by the incongruence between a person’s sex assigned at birth and their gender identity. (4)‍

Those struggling with gender dysphoria may experience profound body dissatisfaction, so much so that they engage in disordered eating behaviors, like excessive exercise, vomiting, and severe caloric restriction, to change the parts of their body that cause them distress or to accentuate desired features. Trans men, for example, may restrict their caloric intake to try to lose fat in traditionally “feminine” locations, such as on the hips.

Gender dysphoria is often confused with body dysmorphia, but they are not the same thing. Those with body dysmorphia experience an extreme fixation on a perceived flaw of their physical appearance, so much so that it impairs their functioning and leads to significant distress. But even if they receive cosmetic care to rectify this “flaw,” the issue is still a psychological issue and tends to persist. As such, it requires mental health counseling and care. Conversely, gender dysphoria is treated with gender-affirming care, such as hormone replacement therapy, and tends to decrease as the person sees the desired changes. 

Whatever the reason, untreated eating disorders can have detrimental consequences on a person’s mental and physical health. The sooner someone seeks treatment, the sooner they can receive the support they need to heal their relationship with food, their body, and movement. 

The Lack of Inclusive & Gender-Informed Eating Disorder Care

One of the major barriers to eating disorder treatment for trans and non-binary individuals is the lack of inclusive and gender-affirming care. Many trans people may not want to seek treatment because of the fear of stigma, discrimination, or incompetence within the healthcare community. (5)

Another barrier to both medical care and safe, gender-affirming care is the lack of providers with an expertise in transgender medicine. Treatment specific to trans patients is not often covered in standard medical curriculum, and many providers don’t have comprehensive knowledge and fluency. Others may have the education but may discriminate against non-binary and trans patients. (5)

Other barriers trans individuals report include: (5)

  • Lack of insurance
  • Lack of income
  • Lack of provider cultural competence
  • Inappropriate electronic records or forms
  • Lack of transportation or stable housing
  • Mental health difficulties

At Within Health, we make inclusivity a top priority, so prospective patients will feel safe, comfortable, and supported throughout their treatment journey. Our virtual treatment program provides patients with the flexibility to continue going about their daily lives, while receiving comprehensive and integrated care from a multidisciplinary team of doctors, nurses, therapists, nutrition counselors, and more. We understand that eating disorders are very complex, and that what works for one person may not work for another. Every patient who starts our program receives an extensive biopsychosocial evaluation, which our treatment team uses to create an individualized treatment plan specific to that patient’s needs and experiences. 

We offer specialized care for transgender and non-binary patients, as well as for queer people of all identities. And our patients can feel comfortable knowing their identities are represented on our treatment staff, as we make it a priority to employ a diverse team of providers.

Posted 
Apr 29, 2022
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Resources

  1. Beckwith, N., McDowell, M. J., Reisner, S. L., Zaslow, S., Weiss, R. D., Mayer, K. H., & Keuroghlian, A. S. (2019). Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center. LGBT health, 6(2), 51–61. https://doi.org/10.1089/lgbt.2018.0136
  2. Wanta, J. W., Niforatos, J. D., Durbak, E., Viguera, A., & Altinay, M. (2019). Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgender health, 4(1), 313–315. https://doi.org/10.1089/trgh.2019.0029
  3. 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. The Journal of Adolescent Health : official publication of the Society for Adolescent Medicine, 57(2), 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003
  4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  5. Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 168–171. https://doi.org/10.1097/MED.0000000000000227

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