Eating Disorders in the Transgender Community

What does transgender mean?

According to the American Psychological Association, “Transgender is an umbrella term for persons whose gender identity [internal sense of being male, female or another identity] or gender expression [how gender is communicated through behavior, clothing, body and other characteristics] does not conform to that typically associated with the sex to which they were assigned at birth.” Simply put, it is a term used when a person doesn’t identify with the sex they were given. For example, if an individual is born and deemed male by a doctor but knows that they are female and chooses to present as such, that person may refer to themselves as being transgender. It is important to note that not everyone who appears gender-nonconforming will identify as transgender. In addition, being transgender is not related to a person’s sexual preferences.

Body image issues in the transgender community

Marginalized groups are often portrayed in the public as one overarching stereotype. This causes conflict when individuals do not adhere to the “norm,” e.g. the norm for cis women is to appear feminine. For transgender folks who already identify outside of what society considers “typical,” societal expectations and body image pressures can be severe and dangerous. Oftentimes society views an individual’s gender validity on how “well” they present or how close to the norm they are. This has the potential to leave those who are transgender struggling to achieve unnatural ideals to fit into the mold for what society deems male or female.

Research about body image in the transgender community has shown two common desires. Transgender men want to appear less curvy and more muscular and transgender women want to appear smaller, thinner, and “more delicate” (Diemer et al., 2015). By no means does this accurately describe everyone’s experience, but for those who wish to alter their body to appear more masculine or more feminine, engaging in disordered eating may become a frequent behavior. An article written for Teen Vogue states, “One thing is certain: transgender youth are using restrictive eating in an attempt to control and manipulate their physical appearance in an effort to attain cis-gendered Western ideals that even most cisgender people can’t attain” (Blair, 2016).

The prevalence of eating disorders in the transgender community

Eating disorders disproportionately affect those who identify as transgender. While the typical image of someone suffering from an eating disorder is that of a cisgender, white woman, a 2015 study found that transgender youth are four times more likely to suffer from an eating disorder and twice as likely to engage in purging (Diemer et al., 2015). Approximately 13.5% of transgender college students report using diet pills and 16% of transgender individuals have been diagnosed with an eating disorder (Eating Disorder Statistics, n.d.).

Eating disorders in the transgender community may be partially attributed to the attempt to more closely match a person’s physical appearance to their gender identity. Transgender men may rely on their eating disorder to lose weight, and thus, lose feminine curves and appear more muscular. Transgender women may engage in disorder eating in an attempt to lose muscle and appear more petite. (Diemer et al., 2015).

Limited inclusive eating disorder treatment

While transgender individuals have the highest rate of eating disorders, they often go without treatment and/or medical care. Transgender people may never pursue eating disorder treatment because of a lack of access, knowledge, and financial ability. Due to, “systematic discrimination within the healthcare industry to refusals to provide care […] transgender people often do without health care” (Access to Health Care, n.d.). Without proper insurance coverage, the cost of treatment is beyond what most individuals are able to afford. In addition, there are few specialized eating disorder treatment centers that have experience working with clients who are transgender.

Even when people do seek out treatment, the experience can often be negative and difficult. Clients who sought eating disorder treatment report suffering macroaggressions, negative experiences, and a lack of gender competence when seeking care (Duffy, Earnshaw, Henkel, 2016). Without treatment that is tailored to an individual’s specific experience, transgender people often choose to not pursue treatment in order to protect their sense of self and wellbeing—even if that means struggling by themselves on their journey to recovery. While we hope that one day this won’t be the reality for transgender individuals, we recognize that it is a reality for thousands of people every year. We want to help.

How to be a good ally

• Validate every individual’s identity. No matter what a person’s identity is, remember that their life experience is valid and important.
• Ask people what pronouns they use and then use them correctly going forward. If you make a mistake, apologize, move on, and remember that in the future.
• Understand that eating disorders look different for everyone. Each patient’s experience with an eating disorder is unique. Just because two people who are struggling with disorder eating are transgender, does not mean that their symptoms, behaviors, and experiences are going to be the same.
• Don’t ask invasive questions. Whether or not a transgender person has had gender-affirming surgery is none of your business.
• Understand that there is no “right” way to be transgender. Transgender people have a right to look, sound, and act however they choose.
• Listen. Chances are that you don’t understand the transgender experience, so make sure you listen to those around you and lift their voices up. Educate yourself by exploring books, blogs, movies, or other social platforms.
• Offer support. If someone in your life is transgender and struggling with an eating disorder, offer to help them find local trans-friendly resources that can help them in their recovery. If they refuse treatment, offer other options, such as online resources, hotline numbers, or simply offer a shoulder to lean on.

As always, The Emily Program is a safe space for transgender individuals to receive eating disorder treatment. We believe each individual is unique and deserves specialized care. If you or a loved one are struggling, reach out to us at 1-888-364-5977 to connect with a personalized treatment team today.

References

Blair, X. (2017). Why Transgender Youth Are More at Risk for Eating Disorders Than Their Peers. Teen Vogue. doi:10.1007/978-981-287-104-6_100002

Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal of Adolescent Health, 57(2), 144-149. doi:10.1016/j.jadohealth.2015.03.003

Duffy, M. E., Henkel, K. E., & Earnshaw, V. A. (2016). Transgender Clients’ Experiences of Eating Disorder Treatment. Journal of LGBT Issues in Counseling, 10(3), 136-149. doi:10.1080/15538605.2016.1177806

Redcay, A. (2015, November 30). Transgender Issues and Eating Disorders. Retrieved June 4, 2018.

Access to Health Care. (n.d.). Retrieved from http://www.transgenderlegal.org/work_show.php?id=2

Transgender People, Gender Identity and Gender Expression. (n.d.). Retrieved June 4, 2018, from http://www.apa.org/topics/lgbt/transgender.aspx