Prevalence of eating disorders 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. Instead, it lumps all LGBTQ+ individuals together under one umbrella, making it difficult to establish prevalence for trans youth on their own.
That said, what research is available shows that eating disorders disproportionately affect transgender youth. One study consisting of U.S. college students revealed that nearly 16% of transgender students had been diagnosed with an eating disorder within the past year. In contrast, fewer than 2% of cisgender heterosexual women reported an eating disorder diagnosis.1 Cisgender queer men and women had much lower rates than 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 compare to the next-highest rates of 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?
The lack of research into the subject makes it difficult to say why transgender youth seem to struggle with eating disorders at higher rates than their cisgender peers. However, this group is generally exposed to unique risk factors that may increase the likelihood of disordered eating behavior, including susceptibility to commonly co-occurring mental health conditions like depression and anxiety.5
Other possible connections uncovered by research include:
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 and disordered eating behaviors
Gender dysphoria may be another factor contributing to the high rate of eating disorders in trans youth. The condition refers to the mental anxiety and distress that results when a trans or non-binary person experiences an incongruence between their assigned sex at birth and their affirmed gender identity.
It’s important to note that not every trans person experiences gender dysphoria. However, those who do may be more vulnerable to developing disordered eating behaviors.6
Pathological and disordered eating behaviors have been found to frequently present in gender dysphoria, manifesting as attempts to suppress certain biological traits, emphasize others, or due to overall body dissatisfaction.6
Barriers to care for trans youth
Unfortunately, transgender youth generally experience barriers to care for high-quality and inclusive eating disorder treatment as well as gender-affirming care.
Some of these barriers 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
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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. Some treatment programs inadvertently end up causing more harm than good—however good their intentions may be. Many trans people report negative experiences with eating disorder treatment, such as:7
- Being misgendered by staff and fellow patients
- Failing to receive care from a clinician who 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
Treatment can be so harmful that many trans people report regretting that they went to eating disorder treatment due to the significant transphobia they experienced.4
Affirming and validating gender during treatment
On the other hand, some treatment facilities are starting to prioritize trans-inclusive eating disorder treatment. However, more 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 many protective factors can reduce the risk of eating disorder development in trans youth, such as:
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 and 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. Still, there is hope, and it starts with access to inclusive, culturally responsive treatment that addresses the whole person. Eating disorders don’t occur in isolation—they are a result of many intersecting biological, sociological, and psychological risk factors, and helping trans youth find quality treatment can help them address all of these factors to have the best chance at recovery.
