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In recent years, eating disorder treatment centers and the treatment world, in general, have made a conscious effort to more openly address the hugely important role gender plays in the development and treatment of eating disorders. Gender is an important part of self-identity; as a pertinent example, cisgender men are expected by society not to suffer from body image struggles or eating disorders, although they happen much more often than the expectation. For this essay, we’ll focus on what has become a defining discussion of the 2020s; the rising recognition of the transgender population, their rights, and their risk factors.

When it comes to eating disorder recovery, the first thing is recognizing the incidence of eating disorders requiring treatment in the transgender community. Although the causes are many, this higher rate of occurrence is largely due to the much higher occurrence of causative factors like body dysmorphic disorder in trans populations as compared to the general community. Per one recent study, transgender college students experienced a rate of eating disorders needing treatment 4 times higher than their peers. Eating disorder treatment facilities, when planning their treatment programs, can certainly include gender-sensitive policies in their treatment programs and among staff.

Understanding this, what can be done to best provide treatment for trans people struggling with disordered eating? Even more importantly, is there any way to reduce eating disorders in the transgender community even before the need for eating disorder treatment arises?

How Gender Impacts the Development of Eating Disorders

First, it must be understood that gender dysphoria is not the sole cause or even the main cause of eating disorders. Eating disorder recovery specialists who focus on transgender eating disorder treatment note that every eating disorder from anorexia nervosa to ARFID is a complex issue stemming from several possible causes. Current thinking indicated that eating disorders are caused by a combination of genetics, upbringing, social pressures, and biology. None of these factors can be ignored, and each influences the way a person relates to their body and the way they eat.

However, certain social and institutional factors raise the risk factors for transgender people with regard to eating disorders.Discrimination in institutions like schools, the workplace, and religious institutions can worsen an individual’s self-esteem. If the person’s family is not supportive and understanding of their gender identity, these feelings of body dissatisfaction and low self-esteem are at even greater risk. Therapy for people struggling with having their gender identity validated and accepted must include gender-sensitive staff and treatment plans.

The problem doesn’t only apply to families and non-medical institutions, either. Despite increasing awareness of transgender people, doctors, psychiatrists, and even mental health care providers can be as slow to recognize the unique needs transgender people have, and this can lead to an inadvertent lack of respect in treatment that reinforces some of the feelings of being misunderstood or ignored that transgender people often experience.

An example might be a transgender man, visiting the doctor, who sees \them consistently using the wrong pronoun in the charts, reinforcing the sense that gender dysphoria is not being taken seriously. Of course, this is most usually not due to malicious intent or bigotry on the part of the provider, but a lack of familiarity with the treatment of transgender individuals. Especially for adolescents who are still forging their place in adulthood, the validation allowed by something as simple as respecting their pronouns helps bolster self-esteem and body acceptance.

Gender and Other Kinds of Mental Health Disorders

Eating disorders only rarely present without any other kind of mental health disorder. According to some studies, as much as 97 percent of people with an eating disorder also present a comorbid disorder like depression, anxiety, PTSD, borderline personality disorder, or OCD (or some combination of them). Comorbid conditions can be a chicken-or-egg situation relating to eating disorders; these conditions can trigger disordered eating behaviors as well as being triggered by them. Because of this, treatment centers must plan correspondingly in a way that addresses all the client’s mental health conditions.

Eating disorder facilities and their staff are used to treating co-occurring disorders like PTSD or anxiety as part of their eating disorder recovery programs, as they are relatively common. However, trans people are also at a higher risk of presenting these disorders. That means the trans population is doubly at risk.

These mental health disorders are known to induce certain behavioral symptoms that are intended to alleviate the negative feelings they create. These are typically known as “coping behaviors.”  They can manifest as drug or alcohol abuse, self-harm (i.e. cutting, etc.), or binging and purging. Of course, these kinds of coping behaviors can become addictive in their own right, and they can become central components of eating disorders like bulimia nervosa and binge eating disorder.

Before reaching the point where eating disorder facilities’ help is necessary, gender-affirming mental health care can identify the presence of anxiety, depression, obsessive-compulsive disorder, or other mental health disorders commonly comorbid with eating disorders. This can assist in preventing the coping behaviors like purging or food intake restrictions that characterize eating disorders. As an example, trans people with body dysmorphia may make attempts to change their body shape to reflect their true gender by engaging in disordered eating behaviors. Gender-sensitive care understands this and works to raise mindfulness of how these behaviors affect emotion. In the case of an especially at-risk group like transgender people, it can help to prevent an incipient eating disorder.

Some Cases of Eating Disorders in the Transgender Population Can Be Prevented

Many of the causes of mental health disorders such as genetic influence, body dissatisfaction or dysphoria, environmental factors like peer pressure, and biological influences can also directly influence the onset of eating disorders, especially through various coping behaviors. Being at a higher risk for both mental health illness and disordered eating and exercise behaviors, trans individuals can be more susceptible to each of them. However, this isn’t a cause for despair; with progressive attitudes prevailing in the transgender eating disorder treatment world, there is always hope.

By respecting each person’s basic human dignity, preventative measures surrounding reducing the need for eating disorder recovery in the trans population is possible. Even something as simple as respecting the client’s preferred nomenclature can make all the difference for someone facing discrimination in large and small ways daily. Added to the compassionate care the cisgender population normally receives for mental health treatment, eating disorders can be reduced in the trans population as well.

Take Advantage of Resources Available to You

The best news of all of this is that gender-sensitive care for eating disorders is more readily available than ever before. Within the world f eating disorder recovery, more and more facilities are making gender-informed care as important a part of their program as trauma-informed care. This remains true for all levels of care; eating disorder treatment is available in residential, day treatment (outpatient), and virtual programming, and each of these usually takes a client’s gender identity into consideration when creating a treatment plan.

For a person living with an eating disorder whose gender identity is not being validated or accepted, it might seem like there is little hope. That’s why gender-informed treatment is so important – it validates each individual as a person and recognizes their unique recovery needs. If you or a loved one needs help, please remember that treatment resources are available. Reach out to a gender-sensitive eating disorder treatment program, and take the first steps to a happier, healthier life.


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.