Recent research has shown that transgender and gender expansive (TGE) individuals had elevated rates of eating disorders when compared to their cisgender peers. This was shown to result from TGE folks being at an increased risk for developing eating disorders due to co-occurring gender dysphoria and trauma from gender minority stressors.
Gender minority stressors such as gender-based victimization and identity non-affirmation increase an individual’s vulnerability to identity-based traumas. Eating disorder behaviours can be used to cope with trauma; therefore, transgender and gender-expansive individuals or clients are at an increased risk of developing an ED or engaging in ED behaviours when experiencing co-occurring identity-based trauma and gender dysphoria.
Gender Dysphoria
Gender dysphoria (GD) creates unique challenges to body image, prompting some TGE individuals to use eating disorder behaviours as a way to change their bodies. GD is used to describe the distress or impairment endured by individuals experiencing incongruence between their gender identity and their gender assigned at birth.
Symptoms of GD may begin in childhood, known as early-onset gender dysphoria, or they may develop around puberty or later in life, known as late-onset gender dysphoria. While symptoms may vary greatly across the experiences of individual TGE clients, GD typically includes:
- Persistent (for at least 6 months) aspirations to be a gender different than the one assigned at birth
- Inconsistency associated with the current or anticipated primary/secondary sex characteristics associated with their assigned sex
- Intense desire to remove the primary and/or secondary sex characteristics of birth gender and/or obtain the characteristics of the desired gender
- A strong belief of having the reactions and feelings typical of someone of the desired gender.
Assessment Models
Two models have been developed to assist clinicians in working with the TGE community but neither one of them specifically address the intersection of EDs, identity-based trauma (IBT) and GD.
The Gender Affirmative Model (CAM)
The GAM recognizes the importance of diverse gender identities and encourages culturally sensitive responses that empower clients to express themselves as authentically as possible. For example, gender-affirmative clinicians work with clients to explore their understanding of gender as an individual journey influenced by biological, social, developmental, and cultural factors.
The Gender Minority Stress Model (GMSM)
The GMSM investigates the impact of internal and external stressors, such as internalized transphobia, identity non-affirmation, and gender-based victimization, on the mental health of TGE clients.
Research on the specific relationship between GD, body image, and EDs within the TGE community is limited. Most of the research available on disordered eating and body dissatisfaction in TGE clients is centered around three themes: TGE clients using ED behaviours to manage their GD, trans-feminine clients striving for the thin-ideal of femininity and trans-masculine clients seeking a toned, muscular ideal of masculinity. The scales used in these studies were developed based on cisgender female clients rather than TGE clients. Further research is needed to design body image and ED measures based on TGE client experiences.
As clinicians, we are in positions to facilitate conversations about the importance of addressing gender diversity within eating disorder treatment, recovery or prevention efforts. We need to advocate not just for our clients but for overall transgender health and human rights. We can also bring our eating disorder expertise into these conversations.
Eating Disorder Care for Primary Care Providers
If you are a clinician looking to learn more about navigating eating disorder care with your clients, register for our free on-demand webinar, First, Do No Harm for Primary Care Providers.
We also offer an online Eating Disorder Care for Health Care Providers (EDC for HCP) course to educate clinicians in primary care about early eating disorder detection and treatment. This course provides clinicians with the foundational knowledge they need to help their patients who are living with eating disorders right away.
