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istorically, eating disorders have been thought to affect thin, white cisgender girls or women, though the reality is, eating disorders like anorexia nervosa (AN), and bulimia nervosa (BN) affect people of all genders, sexualities, sizes, weights, ethnicities, and races; and transgender youth are no exception. In fact, transgender youth, including nonbinary and gender expansive kids and adolescents, are more likely to be affected by eating disorders than their cisgender peers. There are many reasons for this, including risk factors unique to the trans community. 

Prevalence of EDs in Trans Youth and Teens

More research is needed to understand the rates of eating disorders among transgender youth, teens, and young adults. Much of the research that’s out there is not specific to the transgender community—rather, it lumps all LGBTQ+ individuals together under one umbrella, making it difficult to establish prevalence for trans youth on their own.

That said, what little research is available shows that eating disorders disproportionately affect transgender youth. One study consisting of U.S. college students revealed that nearly 16% of the transgender students had been diagnosed with an eating disorder within the past year, while fewer than 2% of cisgender heterosexual women reported an eating disorder diagnosis. Cisgender queer men and women had much lower rates than the transgender students as well, with rates of 2% and 3.5%, respectively. (1)

 Trans college students also reported much higher rates of self-induced vomiting, laxative use, and diet pill use. About 15% had used laxatives or engaged in self-induced vomiting, while over 13% had used diet pills. These figures are eye-opening, given that the next highest rates were 5.2% for vomiting and laxative use and 5.1% for diet pill use among cisgender queer women. (1)

Why Are Trans Youth More Prone to Eating Disorders?

There is no single answer as to why trans youth are more likely to develop eating disorders, but what we do know is that trans youth are exposed to many unique risk factors and challenges that increase the likelihood of eating disorder development, as well as other mental health conditions, such as depression and anxiety. 

Researchers indicate several explanations for the high rates of eating disorders among young trans people, including: (1,2)

  • Trans youth are exposed to higher rates of stigma, discrimination, harassment, bullying, and gender-based violence, which are risk factors for eating disorder development and are linked with poor mental health outcomes.
  • Trans youth may engage in disordered eating to minimize features that may cause or contribute to gender dysphoria.
  • Trans youth may engage in disordered eating to emphasize desired features that affirm their gender or cause gender euphoria.
  • Transmasculine youth may restrict calories, skip meals, or engage in excessive exercise to suppress secondary sexual characteristics and menstruation.
  • Transfeminine youth may engage in disordered eating to lose weight and achieve an “ideal” feminine body.
  • Trans youth may experience many of the same risk factors as their cis peers, such as food insecurity, housing insecurity, and trauma, but due to systemic transphobia, they are more likely to experience these risk factors

Gender Dysphoria May Lead to Disordered Eating Behaviors

Gender dysphoria refers to the mental anxiety and distress that results when a trans or nonbinary person experiences an incongruence between their assigned sex at birth and their affirmed gender identity. 

Every transgender person is unique, and as such, not all trans kids and adolescents experience gender dysphoria nor does gender dysphoria make someone more trans or less trans. That said, gender dysphoria can often lead to disordered eating behaviors in trans youth who experience extreme body dissatisfaction and poor self-esteem. In an attempt to control their appearance and body shape, size, or weight, they may engage in unhealthy behaviors, such as compulsive exercise, diet pills and laxative use, food restriction, and purging. 

The above may be true whether the trans youth understands that what they’re experiencing is gender dysphoria or not. Gender dysphoria is often mistaken for body dysmorphia, in which a person obsessively fixates on a facet of their appearance, whether it’s their weight or something else like their nose or ears, to the point that they experience extreme psychological distress. Unlike gender dysphoria, which is often rectified through gender-affirming care, such as surgery, puberty blockers, and hormone replacement therapy (HRT), body dysmorphia does not go away, no matter how many procedures the person undergoes. Meanwhile, transgender youth who are able to name their feelings as gender dysphoria but are unable to access gender-affirming care may resort to disordered eating behaviors to help alleviate some of the dysphoria.

Barriers to Care for Trans Youth

Transgender youth experience barriers to care for high-quality and inclusive eating disorder treatment as well as gender-affirming care that can be incredibly healing for them.

Barriers to care for trans children, teens, and young people may include: (3)

  • An absence of inclusive and gender-informed care within the medical and mental health community
  • Lack of treatment providers that specialize in transgender medicine
  • Mental health challenges
  • Lack of stable housing or transportation
  • Exclusive medical records or forms
  • Lack of income or insurance coverage 
  • Lack of provider cultural competence

The Need for Inclusive Eating Disorder Treatment

There is a clear gap in the eating disorder treatment community when it comes to inclusive and trans-informed care. In fact, some treatment programs inadvertently end up causing more harm than good, however good their intentions may be. Many trans people report negative experiences at eating disorder treatment, such as:

  • Being misgendered by staff and fellow patients
  • Failing to receive care from a clinician that understands how gender dysphoria may be a risk factor for eating disorders
  • Requiring surgeries before allowing a trans patient to access shared spaces
  • Not having access to gender-affirming care at the treatment facility
  • Not having access to an all-gender or gender-neutral bathroom

In fact, treatment can be so harmful that many trans people actually report regretting that they went to eating disorder treatment due to the significant transphobia they experienced. (4)

Affirming and Validating Gender During Treatment

However, some treatment facilities are starting to prioritize trans-inclusive eating disorder treatment. Therapists and psychologists should be thinking about gender-affirming care as an integrated part of eating disorder treatment, given the connection between gender dysphoria and eating disorders.

Validating and affirming a person’s gender should be top of mind for treatment providers while finding ways to address issues and concerns that may have caused an eating disorder.

Additionally, research indicates that there are many protective factors that can reduce the risk of eating disorder development in trans youth. These protective factors include: (2)

  • Social support
  • Family connectedness
  • School connectedness
  • Compassionate friends

As such, a trans child or teen’s eating disorder treatment plan may include family therapy to improve family connectedness, communication, and boundary setting. Treatment may also include support groups of other trans teens affected by eating disorders, which can help facilitate camaraderie, a sense of community, and reduce feelings of alienation or social withdrawal.

At the end of the day, trans youth are particularly vulnerable to eating disorders, but there is hope and it starts with access to inclusive, culturally-responsive treatment that treats the whole person, including any gender-related needs they may have. Eating disorders don’t occur in isolation—they are a result of many intersecting biological, sociological, and psychological risk factors, and quality treatment will address all of these factors.

Posted 
Jun 21, 2022
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Resources

  1. 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
  2. Watson, R.J., Veale, J.F., and Saewyc, E.M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders 50(5): 515-522.
  3. 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
  4. Malina, S. (2021). Unique Causes And Manifestations of Eating Disorders Within Transgender Populations. Columbia Social Work Review, 19(1), 138–157. https://doi.org/10.52214/cswr.v19i1.7241

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