Understanding the Complex Relationship Between One's Body, Eating, Exercise, and Gender-Affirming Medical Care Among Transgender and Nonbinary Adolescents and Young Adults

Pham, An; Kerman, Hannah M.; Albertson, Katie; Crouch, Julia; Inwards-Breland, David J.; Ahrens, Kym R.

doi:10.1089/trgh.2021.0112

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…Instead, they prioritized culturally competent and affirming, logistically accessible mental health care, integrated into an interdisciplinary care team. As gender‐affirming care was robustly reported to improve patient ED symptoms and behaviors—consistent with prior, albeit limited, research (Ålgars et al, 2012; Nowaskie et al, 2021; Pham et al, 2022)—participants from both groups specified their desire for mental health care to be integrated with clinicians who also provide gender‐affirming care. This desire for integrated ED care with gender‐affirming care, specifically in contrast to promoting body acceptance as within traditional ED treatment paradigms, supports prior research as well (Hartman‐Munick et al, 2021).…”

Section: Discussionsupporting

confidence: 70%

Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

Goetz,

Wolk

2023

Intl J Eating Disorders

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ObjectiveLiterature suggests that transgender, non‐binary, and/or gender expansive (TNG) people are more likely than cisgender peers to experience eating disorders (EDs) and engage in dangerous weight control behaviors. TNG individuals with EDs are dramatically higher risk for self‐harm behaviors, suicidal ideation, and suicidal behaviors than cisgender peers with EDs or TNG peers without EDs, and often engage in ED symptoms/behaviors to alleviate gender dysphoria. Yet, no treatment paradigms have yet been adapted for TNG‐specific ED care. This qualitative study aims to identify stakeholder needs from such care to inform future clinical interventions.MethodsWe elicited patient (n = 12) and mental health clinician (n = 9) stakeholder needs and preferences regarding TNG‐specific ED care. Semi‐structured interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and a behavioral insights framework, EAST, were developed to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. Using a rapid analysis procedure, we produced a descriptive analysis for each group identifying challenges of and opportunities in providing ED care for TNG adults.ResultsStakeholders expressed needs and preferences for TNG‐specific treatment including that it be: (1) TNG‐affirming, weight‐inclusive, trauma‐informed, and anti‐racist; (2) delivered by an interdisciplinary team, including gender‐affirming care clinicians; (3) focused on parsing gender dysphoria from other body image concerns, building distress tolerance, and working toward gender euphoria (rather than body acceptance).DiscussionFuture work is needed exploring ED care delivery models that integrate gender‐affirming care services with mental health care. Such models may improve TNG access to ED treatment and recovery.Public SignificanceTransgender, non‐binary, and/or gender expansive (TNG) experience disproportionately high rates of eating disorders and have unique barriers to accessing care. In individual interviews, TNG adults with eating disorders and mental health clinicians who provide psychotherapy for eating disorders voiced desire for greater availability of TNG‐affirming, weight‐inclusive eating disorder care, integrated with other gender‐affirming care services. This informs future research developing eating disorder care for TNG individuals.

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Section: Discussionsupporting

confidence: 70%

Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

Goetz,

Wolk

2023

Intl J Eating Disorders

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“…Given the significant number of risks for the TGD population, it is essential that clinicians are appropriately informed on how to best assess and treat ED/DEB with this community [ 8 , 22 , 29 , 39 ]. Many of the screeners that are widely used in clinical settings have been developed for cisgender people and may have some questions that are not easily adaptable to TGD patients [ 36 , 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…TGD people may experience gender dysphoria – a significant level of psychological distress that is caused by an incongruence between one’s gender identity and their sex assigned a birth [ 26 ]. This misalignment between one’s gender identity and their primary and secondary sex characteristics is often associated with a high level of dissatisfaction with one’s body and general appearance [ 27 – 29 ]. For many TGD individuals, disordered eating can be understood as a method of “either suppressing or accentuating gender by changing the shapes of their bodies” (pg.…”

Section: Tgd People and Disordered Eatingmentioning

confidence: 99%

“…TGD people who do not “pass” or whose gender expression is outside the gender binary may be susceptible to more transphobic discrimination, harassment, and violence [ 35 ]. As a result, TGD individuals with a binary gender identity (e.g., transgender men, transgender women) may feel tremendous pressure to adhere to social expectations of traditional gender roles and gender expression that cisgender men and women adhere to in order to garner as sense of safety in their communities [ 29 ]. It is important to note that “passing” is not a goal for all TGD people, even with binary gender identities; each TGD person is unique and healthcare clinicians should not assume that “passing” as cisgender is a desired goal or outcome.…”

Section: Tgd People and Disordered Eatingmentioning

confidence: 99%

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Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment

et al. 2023

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Background It has been well established that individuals who identify as lesbian, gay, bisexual, transgender, and queer are at increased risk for mental health pathology, including eating disorders/disordered eating behaviors (ED/DEB). However, less is understood about the unique experiences of transgender and gender diverse (TGD) people who struggle with ED/DEB. Aims The purpose of this literature review is to examine the literature regarding the unique risk factors for TGD individuals who experience ED/DEB through a lens informed by the minority stress model. Additionally, guidance around the assessment and clinical management of eating disorders for TGD individuals will be presented. Results TGD people are at increased risk for developing ED/DEB due to a number of factors including: gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care. Conclusion While guidance around assessment and treatment of ED/DEB for TGD individuals is still limited, adhering to a gender affirmative care model is essential.

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“…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 & ].…”

Section: Gender Dysphoriamentioning

confidence: 99%

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

Keski-Rahkonen

2023

Current Opinion in Psychiatry

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Purpose of review This review summarizes recent research on eating disorders among gender minorities, transgender and gender diverse people. The focus is on research published in 2022 and the first half of 2023. Recent findings Up to 1.2% of young people and 0.3–0.5% of adults identify as transgender, and 2.7–8.4% of young people and 0.3–4.5% of adults report some degree of gender diversity. About 20–50% of transgender and gender diverse people report engaging in disordered eating and >30% screen positive for eating disorder symptoms, and 2–12% have received an eating disorder diagnosis from a health professional. Many transgender and gender diverse people describe eating disorder symptoms as a way of coping with gender dysphoria. They also report high levels of mental and behavioral symptoms, particularly mood and anxiety disorders, suicidal thoughts and behaviors, trauma-related symptoms and disorders, alcohol and substance use, and autism. Gender minorities frequently experience discrimination, victimization, and violence, primarily sexual and physical violence. The minority stress model attributes mental health symptoms to these factors. Promising interventions based on the minority stress model have recently become available, but more research is needed on how to support transgender and gender diverse people with eating disorders. To manage eating disorders in this population, gender-affirming care should be combined with specialist eating disorder treatment. Summary Gender minorities are at high risk for eating disorders. Future studies should assess what is the most appropriate treatment for transgender and gender diverse people with eating disorders.

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Understanding the Complex Relationship Between One's Body, Eating, Exercise, and Gender-Affirming Medical Care Among Transgender and Nonbinary Adolescents and Young Adults

Cited by 10 publications

References 31 publications

Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment

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

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