Anorexia nervosa and gender dysphoria in two adolescents

Abstract

Little has been published about the co-occurrence of gender dysphoria (GD) and eating disorders (ED) in adults, with no cases described in the adolescent population. The emphasis on body shape in both conditions suggests that there may be some overlap in symptomatology. We report two adolescent cases initially diagnosed with anorexia nervosa who later met criteria for GD. The drive for thinness for the 16-year-old male was associated with a wish to achieve a feminine physique whereas there was an emphasis for stunted breast growth and a desire for muscularity in the 13-year-old female. Complexities in presentation, evolution of symptoms over time, and the treatment of the two cases are discussed. Clinicians should inquire about sexual issues in the presentation of ED and should monitor for symptoms of GD, not only at initial presentation, but throughout treatment, especially as weight gain progresses.

Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned

“…This timeline, with gender dysphoria presenting after eating disorder diagnosis, is unique from case reports in adults, which describe the development of an eating Box 1: Definitions of relevant gender terms Gender Identity: An individual's internal sense and subjective experience of gender, which may or may not be the same as one's sex assigned at birth. [10][11][12] MtF patients, in contrast, often report relying on disordered eating to achieve a thinner physique. Transgender: An individual whose gender identity differs from the social expectations for his or her sex assigned at birth.…”

“…A majority of these cases, however, focus on male-to-female (MtF) patients and the drive to appear more feminine, [5][6][7][8][9] often drawing parallels to cisgender females with eating disorders. 12 This report describes a 13-year-old FtM patient initially diagnosed with AN who later revealed a transgender identity but was lost to follow-up before psychological or medical intervention for gender dysphoria. 10,11 Only one previous case report includes a FtM patient who presented during adolescence.…”

Risk Factors for Eating Disorder Psychopathology within the Treatment Seeking Transgender Population: The Role of Cross‐Sex Hormone Treatment

“…As well as presenting to transgender health services with symptoms of an eating disorder, transgender people may initially present to eating disorder services. Case studies have reported on individuals who first present with eating disorder symptoms (e.g., food restriction, vomiting and body image distortion) without disclosing their transgender identity which, through exploration, has later been expressed as a desire to achieve a masculine or feminine body (different to the body associated with their gender assigned at birth) and, hence, identified as secondary to their gender identity (e.g., Couturier, Pindiprolu, Findlay, & Johnson, ; Winston, Acharya, Chaudhuri, & Fellowes, ). These findings are concerning considering that gender incongruence is not routinely assessed within eating disorder services given that the prevalence of transgender people is considered to be low.…”

Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors

“…Little is known about the specific disordered eating experiences of transgender youth, which may be different to cisgender youth (i.e., youth who report a sex assigned at birth that is concordant with felt gender). For example, transgender people may use disordered eating behaviors to attain more masculine or feminine statures and some transgender youth who do not to take hormones may develop disordered eating behaviors to align their bodies with their gender …”