Background:
The treatment of transgender youth with an eating disorder presents particular considerations due to the unique combination of body dissatisfaction, drive for thinness, malnutrition coupled with the evolving gender identity in the midst of biological and physical changes. At this time, public awareness, societal acknowledgment and legislative initiatives have led to wider acceptance of Lesbian, Gay, Bi-sexual and Transgender rights. However, at the same time, transgender youth are at increased risk for mental health problems, including eating disorders.
Objective:
To describe two cases of trans adolescents with anorexia nervosa treated in a day treatment program.
Methods:
In this paper, the two clinical vignettes of transgender adolescent with anorexia nervosa will be discussed. The focused care included specific attention to the initial disclosure of gender identity in a safe space, name and pronoun preferences as well as wardrobe and hair style changes. In addition, treatment focused on the reduction of social anxiety around meal consumption with special attention given to the impact of weight on the development of secondary sex characteristics. Themes of identity, rejection and secrecy were explored.
Conclusion:
In summary, the treatment of transgender youth with anorexia nervosa is more complex than treatment of cis gender youth. Additional issues, such as hormonal treatments, the development of secondary sexual characteristics as well as social and cultural factors can exacerbate eating disorder symptoms. Treatment should focus on understanding the etiology and the trajectory of the disorder within this lens.
Background and goals:
The guidelines for transgender care are evolving
and incorporate a multidisciplinary team approach. These roadmaps entail an
understanding of gender development, mental health, and sociocultural factors in
individual and family lives, as well as the specific medical needs in the process of
transitioning and ongoing treatment. New research is continuing to update the best
evidence-based practice. Multiple professional health organizations have published
guidelines. The World Professional Association of Transgender Health has
pioneered the Standard of Care, currently version seven. Other leading
organizations have their own publications with an emphasis on specific relevant
medical needs. In this paper, The World Professional Association of Transgender
Health Standard of Care and the recommendation of multiple psychiatric and
pediatric organizations are reviewed to provide an overview.
Discussion:
Most current guidelines have similar recommendations in providing
care for transgender individuals. The more recent data has shown the benefits of
medical transitioning in youth and updated recommendations in this age group.
Healthcare professionals are encouraged to stay up to date with these current
guidelines. Further research is recommended.
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