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It’s hardly a secret that young people sometimes struggle with body image and disordered eating. 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. According to a Harvard study, 9% of Americans will experience an eating disorder at some point in their lives, and adolescence is the most frequent time for these disorders to develop. That’s more than 28 million people –not exactly a small number.

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, cisgender young woman – and yet more and more research shows that other demographics are at risk as well.

Not only are more people of different ethnicities and demographics more prone to experiencing an eating disorder than was previously thought, but there is also growing evidence that the gender split is less pronounced. Boys and men suffer from eating disorders (especially binge eating disorder) fairly often, but there remains a societal stigma about seeking treatment. And the increasing awareness about gender identity and transgender rights has brought to light the most at-risk population there is.

Within psychiatric treatment providers, 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. A study completed in 2015 indicated that transgender people experience eating disorders at a rate four times higher than cisgender people.

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

1. Body Image Related to Gender Can Be Complicated

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 was assigned the female gender at birth 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.

Certainly, not every trans person wants to change their body. It’s often a sticking point for trans people when well-meaning but uninformed people ask them about taking hormone treatments or “getting the surgery”. Some people are genderqueer or don’t identify with any gender as well. Despite this, in general, trans people are more susceptible to body image distortions based on their desire to physically attain their true gender.

2. Media Presentations of Beauty and Trans People 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 press 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 an unattainable model of perfection. Unsurprisingly, negative body image is higher in trans people than in the general population.

As we mentioned, trans people are making inroads in representation in the media – but the backlash is still very prominent. Prominent trans figures like national assistant health secretary Rachel Levine (the Biden administration’s appointee for COVID-related issues) and recent Jeopardy!champion Amy Schneider have reached incredible heights, but their achievements still take second place to discrimination and mockery in many media circles. The message this sends to young people with a trans identity is that it’s not safe to come out. This furthers the trauma of facing discrimination – a major factor in the development of eating disorders.

3. Especially for Younger People, Discrimination Takes the Shape of Bullying

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 dissatisfied about their body shape, 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.

As terrible as misrepresentation in the media can be for a person grappling with gender dysphoria, direct, in-person bullying is even worse. Trans teenagers face higher rates of depression, social anxiety, and risk of suicide than any other group. During the throes of adolescence – during which everyone’s body is changing and people are beginning to make their way into the world – peer pressure is especially prominent. Bullying during this period causes lifelong trauma, which causes negative emotions often alleviated by destructive coping mechanisms like disordered eating behaviors.

Eating Disorder Symptoms Can Have Very Different Causes From Person to Person

Disordered eating comes in many forms – food intake restriction, binge eating, purging, avoiding specific types of food, and excessive exercise may all be present in a person struggling with an eating disorder. Eating disorder treatment professionals, naturally, aim to retrain their clients’ behavior and rehabilitate their relationships with food, their bodies, and eating. Examining the root causes of these behaviors is a central part of creating a treatment plan. Many of the standard treatments used in psychotherapy, like Cognitive Behavioral Therapy and Cognitive Therapy put understand how emotions and thinking influence behavior or how trauma influences emotions and thinking.

Because of this, when a trans individual enters treatment, their specific circumstances must be addressed. Transgender people have a higher rate of disordered eating and body dysmorphia in part because they face additional discrimination and uncertainty about being accepted; a treatment program that doesn’t take this into account won’t be as successful in promoting long-term recovery. Specialized treatment can include establishing all-gender treatment facilities welcoming to trans individuals, creating treatment programs that take discrimination-based trauma into account, and hiring healthcare providers experienced with treating transgender individuals (or even better, hiring transgender professionals).

Thankfully, many treatment centers, both for adults and adolescents are beginning to make these changes. Trans individuals still face hurdles in eating disorder recovery, but things are changing for the better. Transgender-informed eating disorder treatment is more readily available than ever.

The Positive News – There Is Transgender-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, in both residential and day treatment settings, are beginning to recognize the serious need for personalized treatment for all genders. Reach out to your mental health professional 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.