Transgender eating disorder treatment & recovery

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Transgender people struggle with eating disorders, and deal with additional barriers to treatment than their cisgender peers, such as gender specific male or female only programs that may not have trans-inclusive care options. Within Health hopes to change this with our inclusive care programs for eating disorders.

Transgender youth are even more susceptible to developing eating disorders. According to a survey conducted by the National Eating Disorder Association (NEDA), over half of LGBTQ+ youths struggle with eating disorders. (1)

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Understanding transgender people with eating disorders

Members of the transgender community face far reaching discrimination due to their gender identity. Some will struggle with disordered eating as part of being exposed to abrasive, painful discriminations about their body image. Stigma and stereotypes make it difficult to talk about, or even get treatment for these disordered eating behaviors.

Transgender people may face discrimination from healthcare providers, such as doctors or mental health professionals, resulting in them not getting the proper care they need. Sadly, many treatment programs have been established, or medical texts written, without careful thought for people who fall outside of the “gender binary” of being male or female. 

Receiving treatment for disordered eating from medical professionals who understand the additional barriers transgender people experience, as well as their unique needs is of the utmost importance. For example, many transgender people, particularly transgender youth do not have a safe, stable home environment where they can find care, and support for their disordered eating. It is estimated that 40-60% of all homeless youth are part of the LGBTQIA community, and when they try to find a home, 1 in 5 transgender people report experiencing discrimination, including eviction, due to their gender identity. (13)

There is therefore a need for increased support, education, and anti-discrimination efforts for the transgender community, especially when it comes to eating disorders and other mental health concerns. (2) By raising awareness, those who cope with an eating disorder, and the people who love them, can access resources to get the support they need and deserve. (1)

Examining stats & trends in transgender people with eating disorders

Studies show that transgender college students are more likely to develop an eating disorder versus their cisgender classmates. (3) Many transgender people with disordered eating also have underlying mental health conditions such as depression, oftentimes connected to stigma and social alienation. Sadly, over 88% of transgender people have reported having suicidal thoughts, with over 40% attempting to end their lives. (11)

Transgender people are often in conflict with their gender identities. They experience heightened rates of gender dysphoria, which is the psychological distress associated with a disparity between one's assigned gender and internal one. Some may develop an eating disorder connected to these feelings of despair over how society sees them. 

Transgender individuals may also experience feelings of inadequacy when it comes to how society perceives them, when many aspects of health care and our larger world try to sort people into the binary of “male” or “female”. Transgender individuals, like their cisgender peers, are socialized into specific gender roles during childhood based on their sex assigned at birth, which may lead them towards negative self-esteem, poor body image, and/or disordered eating.

Transgender people eating disorder signs & symptoms

Members of the LGBTQIA community are at a higher risk of developing disordered eating behaviors due to a complex barrage of psycho-social factors that perpetuate isolation and alienation. 

Transgender people who struggle with an eating disorder will display the same symptoms as cisgender people. These may include: (4)

  • An abnormal and restrictive diet
  • Loss of control over behaviors and thoughts regarding food
  • Obsessive and excessive exercising 
  • Phases of starvation and/or bingeing activities 
  • A negative body image
  • Insecurities surrounding foods

There is a set of diagnostic criteria in the DSM-5 that all people, regardless of gender identity, will display if they struggle with an eating disorder. Generally speaking, people with an eating disorder will present two or more symptoms within twelve months. 

However, each eating disorder has symptoms that vary depending and may present uniquely. The most common eating disorders include: (5) 

Treating transgender people with eating disorders 

It's essential to show understanding and empathy when treating transgender people who struggle with disordered eating. At Within, we recommend all treatment specialists, nutritionists, and health care professionals educate themselves on the specific needs of transgender patients, for a better understanding of the way gender interacts with privilege, discrimination, and internal bias during eating disorder treatment. 

Transgender individuals may experience disordered eating that is connected to concerns about their physical body and/or connected to other complex dynamics associated with co-occurring mental health disorders like depression, and post-traumatic stress disorder (PTSD). 

Every day, clinicians are discovering better ways to provide more reliable and inclusive methods for treating members of the LGBTQIA community who struggle with disordered eating behaviors. Transgender people can begin their treatment process at a program like Within Health’s that accepts LGBTQIA individuals and focuses on gender-inclusive treatment of eating disorders. 

Psychological therapies are available for any transgender individuals with eating or body image disorders and can include some or all of those listed below: (8)

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavioral therapy (DBT)
  • Enhanced CBT for eating disorders
  • Interpersonal therapy (IPT)
  • Social justice empowerment 
  • Mindfulness practices
  • Yoga and movement experiences
  • Expressive therapies including art therapy and psychodrama
  • Family education and family therapy

How transgender people cope with an eating disorder

Eating disorders are challenging to overcome, and transgender individuals may struggle to cope and reach out for help since inclusive environments are not easy to find. Additionally, for many people there are mental, emotional, financial, and environmental barriers to starting treatment in general, let alone finding inclusive care. 

Stigma, discrimination and feeling like they don't fit in are just a few concerns transgender people face when coping with an eating disorder. Other concerns include: (9)

  • Limited treatment options 
  • Fear of rejection
  • Gender stigma
  • Isolation

At Within Health, we aim to help eliminate these barriers, and provide comprehensive care for anyone with an eating disorder. 

How to help a transgender person with an eating disorder 

The same compassion, kindness, and understanding you have for your cisgender friends and family struggling with eating disorders should also be given to your transgender friends and family. 

Treatment protocols for transgender people may vary or include additional types of programs to address gender-related triggers, but much of the eating disorder treatment will be the same. Close attention should be paid to the complex bio-psycho-social variables faced by transgender individuals that can deepen the pain of discrimination and social alienation, and make recovery a more challenging process. 

Despite eating disorders affecting all genders, there is a history of examining disordered eating through the limitations of the gender binary. Eating disorder treatment for transgender people needs to be complex enough to approach their identities without assuming the cause or origins behind someone's disordered eating habits.

Transgender individuals may be more successful in their treatment if they receive care from doctors who specialize in gender-affirming care. This type of care aims to help the patient feel accepted and creates a space of belonging where healing can take place.

Many clinicians who work in eating disorder prevention and screening or treatment programs have started including gender identity-affirmation measures in their practices. (10)

How to parent transgender people with an eating disorder

Parents are advised to avoid placing any pressure or judgment around how their child looks, dresses, or feels on any particular day. Comments made about weight, or exercise can be avoided all together, as even the best intending comments may lead to further body image and self-esteem issues. 

It can be difficult for parents to hear that their transgender child is struggling with an eating disorder. However, working on establishing more open lines of communication-based on listening to your child’s experiences will help support them. 

Parents can consider joining a support group to help them cope with their child's eating disorder. Support groups can be a good source of information on how to manage the relationship by talking with other parents of children with disordered eating behaviors. 

If you are looking for clinically superior care that is attuned to your specific needs call our team at Within Health today. We offer thoughtful, uniquely tailored eating disorder treatment for transgender people, at home or on the go, wherever life takes you. 

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. National Eating Disorders Association. (2019, October 10). Over half of LGBTQ youth in New National Survey have been diagnosed with eating disorders.
  2. Mayo Foundation for Medical Education and Research. (2018, February 22). Eating disorders. Mayo Clinic. 
  3. Liebert Publishers (n.d.) Beyond the binary: Differences in eating disorder
  4. Mennitto, D. (2020, November 12). Frequently Asked Questions About Eating Disorders - Johns Hopkins Hospital.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Press.
  6. National Association of Anorexia Nervosa and Associated Disorders. (2021, March 3). Eating disorder statistics: General & Diversity stats: Anad. 
  7. National Eating Disorders Association. (2018, February 20). Providing better care for transgender and non-binary patients
  8. LGBTQIA Health Education. (2018, February). Addressing Eating Disorders, Body Dissatisfaction, and Obesity Among Sexual and Gender Minority Youth. 
  9. National Eating Disorders Association. (2018, February 21). Eating disorders in LGBTQ+ populations. 
  10. Guarda M.D., A. (2020, December). Expert Q&A: Eating Disorders.
  11. The Trevor Project. (2021, September 22). Facts about suicide. 
  12. National Center for Transgender Equality. Housing & Homelessness.
  13. Fraser, B., Pierse, N., Chisholm, E., & Cook, H. (2019). LGBTIQ+ Homelessness: A Review of the Literature. International journal of environmental research and public health, 16(15), 2677. https://doi.org/10.3390/ijerph16152677

FAQs

Do all transgender people struggle with their body image?

Most people struggle with body image issues at some point, or throughout, their lives. Eating disorders and body image issues are incredibly personal, and vary from human to human. So no, not all transgender people struggle with their body image, but many do.

What causes an eating disorder?

Eating disorders are thought to be caused by a mix of biological, social and environmental factors. When trying to determine what causes an eating disorder, it is important to recognize the biological risks associated with the development of an eating disorder, while also considering the psycho-social experiences of a person who is struggling.

How can I help a person struggling with an eating disorder?

Eating disorders are very serious and should be addressed with professional help. Furthermore, it is critical not to enable the behavior by normalizing unhealthy eating patterns or encouraging others to engage in restrictive eating diet-culture driven eating behaviors. The Within Health team can help answer any questions or concerns you may have regarding disordered eating. Call our helpline today to get started.

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