Provider perceptions of barriers and facilitators to care in eating disorder treatment for transgender and gender diverse patients: a qualitative study

Abstract

Background The prevalence of eating disorders is higher in transgender and non-binary compared to cisgender people. Gender diverse people who seek eating disorder treatment often report struggling to find affirming and inclusive treatment from healthcare clinicians. We sought to understand eating disorder care clinicians’ perceptions of facilitators of and barriers to effective eating disorder treatment for transgender and gender diverse patients. Methods In 2022, nineteen US-based licensed mental health clinicians who specialized in eating disorder treatment participated in semi-structured interviews. We used inductive thematic analysis to identify themes around perceptions and knowledge of facilitators and barriers to care for transgender and gender diverse patients diagnosed with eating disorders. Results Two broad themes were identified: (1) factors affecting access to care; and (2) factors affecting care while in treatment. Within the first theme, the following subthemes were found: stigmatization, family support, financial factors, gendered clinics, scarcity of gender-competent care, and religious communities. Within the second theme, prominent subthemes included discrimination and microaggressions, provider lived experience and education, other patients and parents, institutions of higher education, family-centered care, gendered-centered care, and traditional therapeutic techniques. Conclusion Many barriers and facilitators have potential to be improved upon, especially those caused by clinicians’ lack of knowledge or attitudes towards gender minority patients in treatment. Future research is needed to identify how provider-driven barriers manifest and how they can be improved upon to better patient care experiences.

“It’s beautiful and it’s messy and it’s tragic”: exploring the role of compassion in the eating disorder recovery processes of 2S/LGBTQ + Canadians

“…This would be profound transformation in the delivery of eating disorder healthcare that can dismantle barriers and redefine the experiences of 2S/LGBTQ + patients. Additionally, perhaps having more 2S/LGBTQ + healthcare professionals within eating disorder care could also alleviate obstacles stemming from healthcare providers’ insufficient understanding or biases concerning 2S/LGBTQ + in treatment that other researchers [ 53 ] have noted.…”

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

“…Clinicians specialized in the treatment of eating disorders have described many barriers to accessing and delivering gender-affirming care [60 ▪ ]. Traditional eating disorder treatment is not always effective in gender minorities and it can have a detrimental impact on gender dysphoria [60 ▪ ].…”