Eating disorders are serious mental health issues that can affect people of all genders, including those who identify as transgender or nonbinary. These disorders can affect people from all socioeconomic backgrounds. Unfortunately, these communities have an alarmingly high prevalence of eating disorders, and many of these disorders go undiagnosed as a result of societal prejudices and stereotypes. The purpose of this article is to provide information about the prevalence of eating disorders among transgender and non-binary people, to look into the factors that put them at risk, and to make recommendations for recognizing and compassionately addressing these issues.
Many studies have found that transgender and non-binary people have significantly higher rates of eating disorders than cisgender people. A survey study conducted by Diemer et al. in 2015 found that trans people are over eight times more likely to have been diagnosed with an eating disorder in the past year. On the other hand, this figure is likely underestimated due to the limited diagnostic criteria for eating disorders and the widespread stigma that prevents many people from seeking treatment.
Another study showed that the prevalence of eating disorders in transgender college students is as high as 17.6%, compared to 0.2% for cisgender men and 1.8% for cisgender women.
Contributing Factors That Can Cause Eating Disorders
Transgender individuals often face unique challenges that can contribute to the development of eating disorders. It is critical to recognize that the relationship between disordered eating and having a body that does not conform to gender norms is complex and dynamic. Anti-fat prejudice, cultural background, societal pressures, and gender dysphoria are all potential causes of this condition. The following are some of the most significant factors that contributed:
1. Gender Dysphoria and Body Image: Gender dysphoria, the distress caused by a discrepancy between an individual’s gender identity and their assigned sex at birth, can lead to a negative relationship with one’s body. Many trans and non-binary individuals may develop disordered eating behaviors as a way to cope with this distress, attempting to align their body more closely with their gender identity.
2. Societal Pressures and Cisnormative Ideals: The pressure to conform to cisnormative standards of beauty and gender expression can be overwhelming. Trans masculine individuals may restrict their food intake to achieve a more traditionally masculine physique, while trans feminine individuals may do the same to attain a more feminine silhouette. These pressures are compounded by the need to “pass” as cisgender for safety and acceptance.
3. Food Insecurity: Food insecurity, or the lack of consistent access to adequate food, is another significant factor. Many trans and non-binary individuals face economic instability and discrimination, which can lead to irregular eating patterns and exacerbate disordered eating behaviors.
4. Healthcare Barriers: The exclusionary nature of many healthcare systems means that access to medical transition options like hormones and surgeries is often limited. In the absence of these options, some individuals may turn to disordered eating as a means of controlling their body shape and size.
The need to find comfort in unsupportive or confusing environments can also play a role. Living in a space where one cannot openly express their gender identity can lead to significant psychological stress. This often drives individuals to seek control or solace through their eating habits, which can unfortunately spiral into eating disorders.
Recognizing the Signs of An Eating Disorder
An eating disorder can present itself in a variety of ways, including the following:
- Intentionally restricting food intake.
- Following strict rules about food and exercise.
- Binge eating, which involves consuming large amounts of food in a short period, is often accompanied by feelings of guilt and loss of control.
- Engaging in compensatory behaviors such as vomiting, excessive exercise, or laxative use.
- Experiencing distress and negative body image related to one’s size, shape, or weight.
It is critical to understand that people can exhibit a variety of symptoms associated with disordered eating and that not all of these symptoms are obvious or easy to diagnose.
The Impact of Hormones on Eating Disorders
HRT, or hormone replacement therapy, is an important part of gender-affirming care for a large number of transgender people. However, starting hormone replacement therapy (HRT) can change body composition and weight, which can not only exacerbate existing eating disorders but also lead to the development of new ones. In a culture that stigmatizes being overweight, the possibility that some people will gain weight or have their body fat redistributed as a result of hormone replacement therapy (HRT) may exacerbate their dissatisfaction with their bodies.
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The Treatment of Disordered Eating in Transgender and Non-Binary People
As soon as you suspect that you or someone you know is suffering from disordered eating, seek help from professionals who understand eating disorders and transgender issues. You can do the following things:
- Look for affirming healthcare organizations: Look for medical professionals who have treated transgender and non-binary patients before and who have a nonjudgmental and encouraging attitude toward them. Those who practice Body Trust principles or approach their work from the perspective of Health At Every Size (HAES) may find themselves in a particularly advantageous position.
- Build a Support System: Creating a support network of supportive family members, friends, or peer groups can have a significant impact on one’s development. When you connect with people who have had similar experiences to yours, you can feel less isolated and gain emotional support.
- Focus on Harm Reduction: If the prospect of completely eliminating disordered eating seems overwhelming, you should concentrate on harm reduction techniques. The approach recognizes that even small steps toward healthier habits are considered progress.
Gender-affirmative care is crucial in treating eating disorders because it addresses underlying issues that uniquely affect trans individuals. Unlike traditional care, which might not fully consider the complexities of gender identity, gender-affirmative care listens to and respects the individual’s experience of their own gender.
Trans people often face heightened minority stress and complicated relationships with their bodies. These challenges can exacerbate eating disorder symptoms as individuals may develop unhealthy behaviors to suppress unwanted secondary sex characteristics or seek comfort in unsupportive environments. By affirming a person’s gender identity, caregivers can create a supportive atmosphere where patients feel understood and accepted.
Research shows that when trans individuals receive this type of affirming care, their mental health outcomes improve significantly. Such care is linked to reduced eating disorder symptoms, lower rates of suicide ideation, and decreased instances of self-harm. Essentially, gender-affirmative care offers a holistic approach that not only tackles the eating disorder but also supports the individual’s overall well-being, leading to a more effective and enduring recovery.
Teach not only yourself but also those around you: Learning about the links between disordered eating, gender dysphoria, and societal pressures can help you become a more effective advocate for your needs and gain a better understanding of your own experiences. Disseminating this information to allies is another way to help create a more positive environment.
The Bottom Line
Eating disorders are a significant concern in the trans and non-binary communities, often rooted in a mix of gender dysphoria, societal pressures, and healthcare challenges. Understanding these underlying issues is the first step toward addressing and treating these disorders. Healing begins by focusing on harm reduction, seeking out affirming care providers, and building supportive networks. If you or someone you care about is struggling with an eating disorder, know that support and care are available, and you don’t have to face this journey alone.
