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Three Reasons Transgender People Are at Higher Risk of Developing an Eating Disorder

Eating disorders like bulimia nervosa and anorexia nervosa (not to mention the most common one, binge eating disorder) are well-known – if you’re reading this, you almost certainly know someone who’s struggled with one of these afflictions.  What’s less well-known, however, is that eating disorders affect far more types of people than the common perception would indicate.  The stereotype surrounding an eating disorder patient is that of a well-heeled, white young woman – and yet more and more research shows that other demographics are at risk as well.

In particular, the subject of gender identity has been a center of focus by clinicians specializing in eating disorders. Several recent studies have shown that trans people develop body dysmorphia, anorexia nervosa, bulimia nervosa, and other eating disorders at a higher rate than the general population, putting a population already at risk for higher rates of mental illness and suicide at even higher risk.

There Are Many Risk Factors for Eating Disorders

Clinicians tend to break the risk factors for eating disorders into three categories – biological, environmental, and emotional. These aren’t hard and fast definitions, of course, but instead, a simple way to group the factors. Biological factors include a person’s biological sex (which applies more to cisgender individuals), with women and girls being statistically more likely to develop an eating disorder. Another biological factor is a person’s genetics; a person whose parents have experienced an eating disorder is much more likely to have one themselves.

Environmental factors include the parents as well, further stoking the fires of the eternal “nature vs. nurture” debate. Many studies indicate that children whose parents place high importance on weight loss both for themselves and for their kids are more likely to place such an emphasis n themselves. Other environmental factors include peer pressure, i.e. social pressure to lose weight or keep weight down, and media representations of beauty and attractiveness. The latter includes both traditional media such as magazines and television as well as social media like Instagram and TikTok. Media can influence the way an individual perceives their body and establish unrealistic beauty ideals that might drive them to extreme measures to attain them.

Emotional factors include self-esteem and body image, both of which affect a person’s eating habits when they become distorted. Although not every eating disorder is triggered at least in part by distorted body image, many are, such as anorexia nervosa, bulimia nervosa, and binge eating disorder. Other psychological and psychiatric disorders are also common triggering factors for eating disorders. Primary among these is PTSD, which is found to be a causative factor in a large percentage of cases. Many eating disorder treatment centers use Cognitive Processing Therapy (CPT), a form of therapy designed specifically for trauma response, to treat PTSD. Depression, various forms of anxiety, and other mental health conditions are also common causative factors in the development of eating disorders.

But why is the development of eating disorders more prevalent in the trans community?  We’ll take a look at three reasons that might shed some light on the question.

1 – Body Image Related to Gender Can Be Distorted

A person’s identity and satisfaction with their body are inextricably linked to their gender.  If their biological sex doesn’t match their true gender, a person’s perception of their body shape and attractiveness can easily be distorted.  For example, someone who identifies as male but is biologically female may be distressed by the presence of breasts or fattier areas like the hips which are stereotypically female.  For a woman who is in a male body, there might be distress over heavier musculature in the chest and shoulders or the presence of facial or body hair.  These feelings can expand into actions taken to reduce those satisfactions, which can also be contributing factors to an eating disorder.

2 – Media Presentations of Beauty Can Lead to Negative Body Image

Although in recent years there has been increased visibility for more diverse body types, in general, TV, Hollywood movies, and advertising still presses forward the same beauty standards as always – skinny, conventionally beautiful women and slim, muscular men.  These representations and the desire to match them already have a strong influence on cisgender peoples’ self-image.  For transgender people, that perception can be amplified when combined with an already-dissatisfied self-image.  Imagine being fundamentally dissatisfied with your body because it’s the wrong gender – and then seeing representations of your true gender that have been photoshopped into a basically unattainable model of perfection.  Unsurprisingly, negative body image is higher in trans people than in the general population.

3 – Bullying Is Real, and It’s a Problem

Bullying has always been there – probably back to the beginning of human societies.  While it certainly carries some physical risks, i.e. getting beaten up after school, the real damage is psychological.  When a person is picked on at school, at work, or even by members of their family, the insults and constant perception of inadequacies can take their toll – a person can begin to believe the things being said about them.  For transgender people, who often already feel conflicted about their body shape and feel dissatisfied with it, bullying can act as a catalyst for extreme dieting or even self-harm. The most tragic aspect of this reality is that trans people face discrimination and bullying at very high levels, even sometimes officially.

Some Good News – There Is Trans-focused Treatment Available

If you or a loved one is struggling with an eating disorder and is transgendered (or otherwise queer) it might seem like there’s no avenue of escape.  The good news is that more and more eating disorder treatment facilities, both inpatient and outpatient, are beginning to recognize the serious need for personalized treatment for all genders.  Reach out to your doctor or research for yourself – and locate hope and help today.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.
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