Eating disorder treatment programs for non-binary people

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Non-binary people struggle with eating disorders, just like every other gender. When a person has an eating disorder, they may feel alone, as though no one understands the pressures they feel to look a certain way. This can be felt even more deeply for non-binary people who may not feel like there is a program accepting of their gender, as most are based in the binary of male or female programs. In addition, access to specialized care has not yet been prioritized within the eating disorder field.

However, intentionally inclusive care practices for non-binary people with eating disorders are beginning to emerge, such as the treatment programing offered at Within Health.

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In this article

Understanding non-binary people with an eating disorder

Many people, including non-binary people, experience disordered eating at some point in their lives. Multiple factors can cause disordered eating, including body dysphoria, and poor self-esteem due to societal expectations put on gender. Eating disorders may also develop in conjunction with an underlying mental illness, such as anxiety, depression, or post-traumatic stress disorder (PTSD). In fact, PTSD is oftentimes tied with interpersonal and other forms of trauma connected with the non-binary experience, leading to disordered thinking about food intake. (1)

Causes of disordered eating vary for everyone and depend on a variety of bio-psycho-social factors that could affect everyone, regardless of their gender. These include may include things like family history, societal pressures, an unstable home environment, and past or present trauma (1)

Examining stats & trends in non-binary people with eating disorders 

It is estimated there are 1.2 million non-binary people living in the United States, though in reality the number is likely much higher. (2) Of those, around 7.4% of the non-binary population self-identify as having an eating disorder. (3)

Many non-binary people struggle with gender dysphoria— the psychological distress associated with the disparity between biological gender and their internal gender identity. It's true that not every non-binary person struggles with gender dysphoria. Although, sadly, those that do often battle with an eating disorder resulting from their dislike of their appearance. (4) This “dislike” is better understood as an incongruence between their body’s presentation of biological gender and their own internal experience of gender. 

Another concern is body dissatisfaction—a person's negative evaluation of their appearance. This is a risk factor for mental illnesses, especially those contributing to eating disorders. (4) All of these factors can lead to poor body image, which in turn may lead to disordered eating.

According to the American Society of Nutrition, eating disorders are on the rise. (5) With the intensity of overwhelming pressures placed on non-binary people to conform to the gender assigned to them at birth, it's no wonder why. These additional stressors can result in the development of disordered eating behaviors.

Non-binary people eating disorder signs & symptoms

Eating disorders affect people of all genders and usually present the following symptoms: (1) 

  • An irregular and restrictive diet
  • Loss of control over thoughts or behaviors surrounding food
  • Compulsive exercising 
  • Periods of starvation and/or bingeing behaviors 
  • Negative body image
  • Food insecurities 

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has a set of criteria that any person, regardless of gender identity, will display two or more of within a twelve month period. This varies with each eating disorder classification yet includes emotional and behavioral symptoms lasting no fewer than six months. (6)

Treating non-binary people with eating disorders 

When treating non-binary people with eating disorders, it is important to be sensitive and experience authentic empathy. Health care professionals and treatment specialists should do their best to provide compassionate care, free from bias or stigma and should educate themselves around this topic as a critical aspect of becoming specialized in treatment of non-binary people with eating disorders

When looking for a treatment program, a non-binary person may wish to seek treatment at a gender-inclusive treatment program, like the ones offered at Within Health. 

There are behavioral therapies available for eating and body image disorders. These include combinations of (7):

  • Cognitive behavioral therapy (CBT)
  • Enhanced CBT for eating disorders
  • Interpersonal therapy (IPT)
  • Dialectical behavioral therapy (DBT)
  • Group therapies 
  • Nutrition therapy and monitoring
  • Family education and therapy

How non-binary people cope with an eating disorder


Since many non-binary people struggle to feel accepted, and experience interpersonal rejection, bullying and other invasive and painful interpersonal exchanges coping with an eating disorder is even more challenging. Not only is there a struggle for acceptance, but they are oftentimes misunderstood. 

Even if their gender beliefs are accepted by those around them, non-binary people may not feel supported when dealing with feelings about their body image. That's why it's important for those with a loved one who is non-binary and struggling with an eating disorder to offer all the unconditional support their loved one needs. In addition, it is imperative that loved ones learn about the experience, how to communicate, and most effectively provide this support to their loved one.

Non-binary people who don't feel as though they have the love and support from their friends and family will often suffer with their disordered eating in the following ways:

  • Silence: Non-binary people deal with unique challenges while seeking support. For that reason, many suffer in silence about their disordered eating. (8)
  • Limited treatment options: treatment programs for eating disorders rarely address the complexities of disordered eating among the non-binary population, limiting their treatment options.
  • Fear of rejection: Some fear their treatment will not be taken seriously because they are nonbinary. (4)
  • Gender stigma: People have long assumed that only women deal with eating disorders. Furthermore, the literature and language around disordered eating behaviors have been geared towards women and exclusive of other gender identities. The truth is, all genders struggle with disordered eating. Studies show that transgender and non-binary people are2-4 times more likely to develop an eating disorder than women. (7)
  • Isolation: Many non-binary people cope with their eating disorders alone, leading to malnutrition or weight loss. (9)

Non-binary people with an eating disorder face many extremely harsh and damaging stigmas. For that reason, they may be unwilling to disclose their gender identity or their eating disorder. (4)

How to help someone with an eating disorder 

The best way to treat non-binary people with an eating disorder is through a treatment center dedicated to providing inclusive care with truly empathic, and knowledgeable providers, preferably with access to providers who are themselves non-binary and or groups of other patients who are also non-binary, so that a person can benefit from a shared experience and a new sense of belonging.

Historically, eating disorder treatment centers are organized along gender binary lines, which is only inclusive of people who identify as male or female. 

Non-binary individuals have a better chance at recovery if they are treated by clinicians specializing in eating disorders and gender-affirming care. Clinicians involved in eating disorder prevention, screening, and treatment are now beginning to create more affirming spaces for transgender and gender non-binary people. (7)

How to parent a non-binary person with an eating disorder

The most important thing a person can do for their child who is non-binary and struggling with an eating disorder is to be supportive and accepting. Offering understanding and compassion are vital steps in beginning the recovery process.

Parents can try to do their best to keep the lines of communication open with their non-binary children with eating disorders. This allows their child to feel more comfortable about sharing their struggles with disordered eating. 

Sometimes parents unknowingly engage in behaviors, make assumptions, or express beliefs that can negatively impact a person with an eating disorder in their non-binary child. If this occurs, parents can learn to be aware of this and make a change. Sometimes parents need education and support around this subject. Family therapy can be an effective way for parents to learn and understand more about their own biases and beliefs, while opening communication and creating a space for mutual respect, care, validation and communication.

Finally, family members may also consider joining a support group. They will afford them a better understanding of the eating disorder and thus be equipped to help their family members and place more attention on their own belief systems and patterns of behavior that may be worthy of self-reflection and healing. Treatment specialists who understand the complexities and nuances in working with a family with a non-binary individual experiencing an eating disorder can help develop a treatment and recovery plan that offers support and guidance to parents and their non-binary children with an eating disorder. (9)

Family members of a non-binary person with an eating disorder can assess their own biases and stigma, and become further educated on disordered eating. Hopefully, through this process, the family will be able to provide authentic acceptance, validation and compassion toward their loved one, allowing for a deeply meaningful healing process.

If you or someone you love is looking for healing from disordered eating, Within Health has inclusive programs built specifically for non-binary people. Call our clinical care team now to learn about our virtual treatment program for eating disorders.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Mennitto, D. (2020, November 12). Frequently Asked Questions About Eating Disorders. Johns Hopkins Hospital.
  2. Dowd, R (2021, June 22). 1.2 million LGBTQ adults in the US identify as nonbinary. Williams Institute
  3. Diemer, E.W., White Hughto, J.M., Gordon, A.R., Guss, C., Bryn Austin, S., & Reisner, S.L. (2018). Beyond the binary: Differences in eating disorder prevalence by gender identity in a transgender sample. Transgender Health, 3(1), 17-23. 
  4. Diemer, Elizabeth W., Jaclyn M. White Hughto, Allegra R. Gordon, Carly Guss, S. Bryn Austin, and Sari L. Reisner. (2018) Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. Transgender Health 3 (1): 17–23.
  5. Graber, E., (2021, February 24). Eating disorders are on the rise. American Society for Nutrition.  
  6. Mayo Foundation for Medical Education and Research. (2018, January 25). Oppositional defiant disorder (ODD). Mayo Clinic. 
  7. Allegra, R. G., Moore, L. B., Guss, C. (2021, April 13). Eating Disorders Among Transgender and Gender Non-binary People. Springer Link.
  8. LGBTQIA Health Education. (2018, February). Addressing Eating Disorders,  Body Dissatisfaction, and Obesity  Among Sexual and Gender Minority  
  9. Health for a Better World. (2020, October 10). How eating disorders can lead to malnutrition. 
  10. Guarda M.D., A. (2020, December). Expert Q&A: Eating Disorders.

FAQs

Do all non-binary people struggle with their body image?

No. Not every non-binary person struggles with body image issues. However, many do, so they often feel they cannot get the right treatment for their eating disorder.

Does a non-binary person struggling with an eating disorder qualify for higher levels of care in the treatment of eating disorders?

Yes. Many treatment centers offer co-ed inpatient treatments. Within Health provides treatment for anyone struggling with an eating disorder, regardless of their gender identity. However, access to care in an inclusive environment has been widely considered an issue within the non-binary community.

Is there an eating disorder treatment designed for non-binary people?

No. However, there are treatment programs, like the one offered through Within Health that are inclusive and with a special focus on creating a loving, attuned space for individuals experiencing the complex circumstance of being non-binary and having an eating disorderThese programs are open and accepting of all identities. In addition these environments must display extra care and attention to creating safe spaces and a sense of belonging for those who require higher levels of care.

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