“How Do I Exist in This Body…That’s Outside of the Norm?” Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia

Abstract

Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark’s thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.

Eating disorders in transgender and gender diverse people: characteristics, assessment, and management

“…Disordered eating, particularly food restriction, may be a strategy of dealing with gender dysphoria and a changing body [46,47,48 ▪ ]. In a qualitative study of gender diverse people living with eating disorders, participants explained that their eating disorders represented attempts to cope with body dissatisfaction, gender dysphoria, and feeling disconnected from the body [48 ▪ ]. Experiences of discrimination and pressures from gender norms around thinness, fatness, and muscularity were major contributors to their body dissatisfaction and gender dysphoria [48 ▪ ].…”

“…In a qualitative study of gender diverse people living with eating disorders, participants explained that their eating disorders represented attempts to cope with body dissatisfaction, gender dysphoria, and feeling disconnected from the body [48 ▪ ]. Experiences of discrimination and pressures from gender norms around thinness, fatness, and muscularity were major contributors to their body dissatisfaction and gender dysphoria [48 ▪ ]. Some participants also attempted to meet the weight requirements of gender-affirming surgery by focusing on their weight in an unhealthy way [48 ▪ ].…”

“…Experiences of discrimination and pressures from gender norms around thinness, fatness, and muscularity were major contributors to their body dissatisfaction and gender dysphoria [48 ▪ ]. Some participants also attempted to meet the weight requirements of gender-affirming surgery by focusing on their weight in an unhealthy way [48 ▪ ].…”

“…Gender dysphoria may contribute to body dissatisfaction and the onset of disordered eating [45]. Disordered eating, particularly food restriction, may be a strategy of dealing with gender dysphoria and a changing body [46,47,48 ]. In a qualitative study of gender diverse people living with eating disorders, participants explained that their eating disorders represented attempts to cope with body dissatisfaction, gender dysphoria, and feeling disconnected from the body [48 & ].…”

Nutritional considerations for gender-diverse people: a qualitative mini review

“…Notably, many trans men and non-binary people assigned female at birth (AFAB) are denied chest masculinization surgery due to BMI limits set by surgeons ( 5 ). When considerations such as these are not accounted for, nutritional care—particularly eating disorders treatment—may be less effective or even iatrogenic ( 6 ). In fact, several qualitative studies have reported that the efficacy and acceptability of gender-diverse participants' eating disorders treatment experiences hinged on whether their gender identity was considered during recovery [e.g., ( 3 )].…”