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Why Transgender People Are More Likely to Develop an Eating Disorder
Contributor: Staff at McCallum Place
Prevalence of Eating Disorders Among Transgender People
An extensive survey published in the Journal of Adolescent Health sampled nearly 300,000 U.S. college students about their self-reported eating disorder diagnoses and compensatory behaviors . The researchers found that 15% of the transgender people surveyed reported an eating disorder diagnosis within the last year, compared with 3.52% of cisgender sexual minority women, 2.06% of cisgender sexual minority men, 1.85% of cisgender heterosexual women, and 0.55% of cisgender heterosexual men.
The transgender students who participated in the survey also reported much higher rates of compensatory behaviors than their cisgender peers. Within the past month of being surveyed, 13.5% of transgender students reported using diet pills, compared with 5.11% of cisgender sexual minority women, 4.29% of cisgender heterosexual women, 4.16% of cisgender sexual minority men, and 1.88% of cisgender heterosexual men.
And 15% of the transgender students vomited or used laxatives within the past month of being surveyed, compared with 5.24% of cisgender sexual minority women, 3.71% of cisgender heterosexual women, 3.69% of cisgender sexual minority men, and 0.67% of cisgender heterosexual men.
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The numbers are quite staggering, with transgender men and women struggling with eating disorders at a disproportionately higher rate than cisgender individuals.
Why Transgender People Are at a Higher Risk
Eating disorders are complex illnesses that often do not have a single cause. There are many factors that can influence why a transgender person may develop an eating disorder, including:
- Coping with stress or trauma from discrimination or violence they have experienced because of their transgender identity
- Trying to create gendered features, whether masculine or feminine
- Attempting to conform to a masculine or feminine “ideal” 
According to the Journal of Adolescent Health, there is a logical reason why eating disorders are such a prominent challenge for transgender individuals compared with cisgender people, namely, that body dissatisfaction is one of the strongest predictors of developing an eating disorder, while gender embodiment or presentation is critical for many transgender people .
Although not all transgender individuals wish to change their bodies, some choose to undergo gender confirmation surgery, other surgeries that create masculine or feminine features, or hormone replacement therapy. But some transgender individuals may start with dieting and exercise as the less invasive, less expensive option, and this can lead to unhealthy, disordered behaviors as they strive to achieve the “right” body.
“In treating transgender patients with eating disorders, we understand that gaining weight is especially difficult as their weight served a very real function for them,” Janine Averbach, MSW, LCSW, senior primary therapist at Princeton Center for Eating Disorders, told Penn Medicine News in a blog post. “Specifically, transgender females often use symptoms such as restricting, purging, or exercising to achieve a more feminine appearance, and transgender males often use the same symptoms to suppress secondary sexual characteristics and menstruation .”
Transgender author and speaker Ryan Sallans experienced the challenges of living with an eating disorder firsthand. “At 19, a sophomore in college, I was newly diagnosed with anorexia nervosa. … I did find comfort in the fact that the way I ate (or didn’t eat) brought me a more masculine figure. I didn’t have hips or breasts. I stopped menstruating, so I didn’t have a traumatic monthly reminder that I could carry a child,” Sallans told the San Francisco AIDS Foundation in a blog post .
While eating disorder symptoms might look the same among cisgender and transgender individuals, the influences that can bring about these compulsions are likely quite different. And that can create challenges as diverse as the people struggling with them.
A Need for Specialized Treatment
Most people who identify as transgender have likely already experienced some form of discrimination, trauma, or violence, so seeking help for an eating disorder can be frightening . Simply finding a behavioral healthcare provider who respects their basic rights, such as using their correct name and pronouns, can be challenging.
Eating disorders affect everyone differently, regardless of their gender identity, and people who identify as transgender have the right to care that addresses their specific challenges. Seeking eating disorder treatment that respects their identities and needs is crucial to getting on the path to long-term wellness.
References Diemer, E. W.; Grant, J. D.; Munn-Chernoff, M. A.; Patterson, D. A.; and Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 57(2), 144–149. doi:10.1016/j.jadohealth.2015.03.003.  Griffiths, S. and Yager, Z. (2019). Gender, embodiment, and eating disorders. The Journal of Adolescent Health. 64(4), 425-426. DOI: https://doi.org/10.1016/j.jadohealth.2019.01.016.  Harvey, R. (2019). Eating disorders do not discriminate: trans teens face greater risk. Penn Medicine News. Retrieved from https://www.pennmedicine.org/news/news-blog/2019/march/eating-disorders-do-not-discriminate-trans-teens-face-greater-risk.  Sallans, R. (2018). My life with anorexia as a trans man. San Francisco AIDS Foundation. Retrieved from https://www.sfaf.org/collections/beta/my-life-with-anorexia-as-a-trans-man/.
About The Sponsor
McCallum Place is an eating disorder treatment center with locations in St. Louis, Missouri, and Kansas City, Kansas. We provide comprehensive treatment for adolescents and adults. We also offer a specialty treatment program for athletes who are living with eating disorders. Our experienced treatment team works closely with each patient to ensure that they play a central role in their recovery process. We offer a full range of services to meet the unique needs of each patient and address all issues related to the treatment of eating disorders.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Reviewed & Approved on February 18, 2020, by Jacquelyn Ekern, MS, LPC
Published February 18, 2020, on EatingDisorderHope.com