Individuals with eating disorders are not all the same and each individual has a unique lived experience. Transgender and non-binary people are at increased risk of developing eating disorders. This is a two-part blog series that focuses on gender-affirming care. Part one will discuss why gender-diverse people are at increased risk for the development of eating disorders. Part two covers how we can foster spaces that are affirming, inclusive and safe so this population doesn’t have to suffer in silence.
Why are gender diverse people susceptible to eating disorders?
Transgender and non-binary people are at increased risk for the development of eating disorders compared to their cisgender counterparts. Recent research among transgender youth in Canada between 14 to 18 years of age found that 42%, 48%, and 18% reported engaging in binge eating, fasting, and vomiting for weight control, respectively [1].
With these high rates of eating disorders, you may be wondering why are gender diverse people susceptible to them?
Before answering this question, it is important to understand the distinct definitions of gender dysphoria and body dysmorphia.
GENDER DYSPHORIA
Includes intense dissatisfaction because of a mismatch between one’s outer self and one’s self-perception of gender. For example, this may include a desire to get rid of primary (ex. genitals) and/or secondary sex characteristics (ex. breasts, facial hair, hip widening, and Adam’s apple), to have the sex characteristics of a different gender, and/or a strong desire to be a different gender and to be treated as such.
BODY DYSMORPHIA
Includes intense dissatisfaction from a perceived distortion of body weight and shape and/or preoccupation with body weight and shape.
The more gender dysphoria one feels, the more body dissatisfaction one experiences. Body dissatisfaction is thought to play a central role in the onset and maintenance of eating disorders. Among gender-diverse youth and adolescents, a major contributing factor to body dissatisfaction is pubertal change and the development of secondary sex characteristics. As such, transgender and non-binary individuals are at elevated risk of eating disorders.
In addition, among youth who identify as gender diverse, there is stress associated with being a gender minority including stigma, bullying, safety concerns, and the potential of familial rejection. Many gender-diverse individuals experience stress that cisgender people often don’t think about. For example, the availability of gender-inclusive bathrooms in public places. This stressor can lead to the omission of eating and drinking. The cumulative effect of all gender minority stressors can have a negative impact on health.
Common difficulties faced by gender-diverse individuals when seeking treatment
A recent study published in 2016 showed 40% of participants hid their gender identity and did not disclose it while seeking eating disorder treatment [2]. The reported reasons for withholding their gender identity included fear of stigma and discrimination because of negative past experiences in the health care setting [2]. Unfortunately, it is not uncommon for the voices of transgender and non-binary individuals to be dismissed or silenced. These individuals often worry that their gender will prevent them from receiving appropriate treatment, or that their medical issues will be overlooked because of their gender [2]. This may be in part due to a lack of access to gender-affirming care and to both overt and subtle discrimination against the gender-diverse population by healthcare providers. This has been shown to be the primary contributor to suboptimal healthcare in this group. In addition, not honouring their gender identity can impede successful treatment [3]. In instances when gender identity is exposed to their healthcare provider trans and non-binary youth may be fearful of not passing (meaning folks being perceived as one’s true gender, not the sex assigned at birth).
How to foster a safe environment for gender-diverse individuals?
CONSENT
Obtaining informed consent in the session and ensuring that client, staff, and family are aware of the consent laws.
LANGUAGE CONSIDERATIONS
Asking for the client’s name and pronouns. Listening and validating emotions and demonstrating that their needs are taken seriously while adopting a posture of openness and humbleness.
VALIDATING BODY ACCEPTANCE
Validating that it is normal to not like your body in a society that constantly tells us something is wrong. It’s normal to change your body to fit your true gender and want to fit in with society. Understanding if body acceptance is about gender dysphoria, and/or having internalized an unrealistic beauty standard, and/or body dysmorphia.
UNDERSTANDING GENDER DYSPHORIA
It is important to understand the contributing factors towards body dissatisfaction and their connection between disordered eating behaviours which may aim to decrease or prevent the development of secondary sex characteristics. Similarly, understanding societal expectations of body size and shape and the media’s influence on the degree of masculinization and feminization is not achievable by both cisgender and transgender individuals.
Conclusion
Providing inclusive care for gender diverse people could change access to treatment for eating disorders. As a healthcare provider, it is your job to receive training on this topic so your patients and clients feel heard and safe in your office – it is not the client’s role to educate you. In the next post, we will discuss specifically the role of the dietitian in this treatment. If you worry you are suffering from an eating disorder and don’t know where to turn to for inclusive care, please reach out to our team at info@sooma.ca or 514-437-4260.
By: Aviva Rappaport, McGill Dietetic Intern
Sööma est une entreprise bilingue qui fonctionne en anglais et en français. Nous fournissons des articles de blogue, des recettes et des articles de diverses sources qui sont parfois écrits en anglais et parfois en français. Si vous vous sentez incapable d’accéder à un article ou à un sujet spécifique en raison d’une barrière linguistique, veuillez nous contacter à info@sooma.ca et nous serons heureux de traduire le contenu pour vous.
Sööma is a bilingual company that operates in both English and in French. We will provide blog posts, recipes and articles from various sources that are sometimes written in English and sometimes in French. If you feel unable to access a specific article or topic due to a language barrier, please reach out to us at info@sooma.ca and we will be happy to translate the content for you.
References
- Watson RJ, Veale JF, Saewyc EM: Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. Int J Eat Disord 2017, 50:515-522.
- Duffy ME, Henkel KE, Earnshaw VA: Transgender Clients’ Experiences of Eating Disorder Treatment. J LGBT Issues Couns 2016, 10:136-149.
- Grant J, M,, Mottet L, A,, Tanis J, Harrison J, Herman J, L,, Keisling M: Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. vol. 2011. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.
