Eating Disorders and Transgender People

Cohort studies and clinical reports indicate a higher prevalence of eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder) among transgender young people than in the general population.

What is known

Cohort studies and clinical reports indicate a higher prevalence of eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder) among transgender young people than in the general population. Physical dysphoria and the desire to influence secondary sex characteristics may play a role.

Clinical implications

Eating disorders require specific treatment. When eating disorders and gender dysphoria occur together, international guidance recommends diagnosing and treating both conditions seriously and in a carefully considered order. Acute medical instability caused by an eating disorder may be a reason to postpone hormone treatment.

How the two are connected

For some young people, the eating disorder serves a function in relation to discomfort with their body. Girls may stop menstruating and slow the development of their breasts and hips by losing a significant amount of weight. Boys may try to maintain a slim, less masculine body. The reverse also occurs: a young person with an eating disorder and a strongly negative body image may interpret their aversion to their own body as gender dysphoria. At the outset, it is often impossible to say which of the two came first.

Overlap with autism

Anorexia, like gender dysphoria, is more common among girls with autism. For some young people, all three therefore occur at the same time. Clinicians see the same characteristics recurring: rigid thinking, a strong need for control and difficulty coping with the changes of puberty. How sensory processing and body image in autism are connected to gender dysphoria is explored by genderautisme.nl. See autism and transgender.

Treatment order

An eating disorder is a serious illness with physical risks and takes priority in treatment when weight is dangerously low. Malnutrition also affects thinking and mood, making it more difficult to make a well-considered decision about an invasive treatment. Some young people say that recognition of their gender identity helps them recover; for others, their discomfort decreases once the eating disorder has been treated. This argues for a clinician who understands both problems. The Cass Review recommends that every young person receive a comprehensive assessment that includes eating problems. See also depression and transgender.