Transgender Eating Disorders: Understanding Bulimia Nervosa and Gender Dysphoria

When most people think back to what they have seen in the media and read online about people with an anorexia nervosa or bulimia nervosa diagnosis, they likely picture a young, cisgender, white female. Unfortunately, this is because mainstream media has been helping to create an inaccurate stereotype surrounding eating disorders. But eating disorders like anorexia nervosa, binge eating disorder, and bulimia affect people of all ages, races, sexual orientations, cultural backgrounds, sexes, and genders. Someone can be queer, homosexual and transgender – and have a bulimia nervosa diagnosis.

In general, research shows that transgender people with eating disorders are now being diagnosed at much higher rates than ever before. Even in a group that is understudied and largely underrepresented in research studies, it is clear that there are many correlations between gender identity, gender dysphoria, negative body image, and eating disorders.

What Does Transgender Mean?

The word “transgender” is recognized as an umbrella term that is used to describe someone whose gender identity does not match the sex that they were assigned when they were born. An individual’s internal sense of their sex, whether they define themselves as male, female, neither or something else is their gender identity. If someone is cisgender, they identify with the sex they were assigned at birth.

For example, you may meet a transgender person who identifies as a man but was born with female genitalia and assigned as a female at birth. Research suggests that there are almost 700,000 Americans who identify as transgender in the US today. However, it’s important to note that gender identity and gender dysphoria are complex, and the term transgender can mean different things to different people. It is also possible for someone to have a gender identity that doesn’t fit in neatly as either male or female. In this case, they may identify as genderqueer or gender non-conforming.

Transgender Eating Disorders: How Do They Develop?

There is intense pressure for most Americans to fit in with the ideal body type that is praised in US culture. Whether someone identifies as cisgender, transgender or somewhere in between, societal expectations and body image pressures can be very extreme and dangerous. And for those who are also under pressure to “present” as the gender that they identify with, this can quickly result in anxiety, depression, and negative body image issues.

For someone who is already trying hard to make their body fit in with the gender they identify with, this pressure can result in disordered eating behaviors. Some research has been done concerning body image in the transgender community, and it shows that trans men would generally like their body to appear less curvy and more muscular, while trans women would like their body to appear smaller and thinner. While these are merely generalizations, many transgender people are willing to go to dangerous lengths to feel more comfortable in their bodies.

How Prevalent Are Eating Disorders in the Transgender Community?

Studies suggest that transgender people are disproportionately affected by eating disorders than their cisgender peers. In fact, a 2015 study showed that transgender youth are 4 times more likely to develop an eating disorder and engage in purging behaviors twice as often. Additionally, over 13 percent of transgender college students have used diet pills and 16 percent have officially been diagnosed with an eating disorder.

Researchers have also determined that transgender and gender non-conforming individuals who were assigned female at birth have a much higher risk of developing an eating disorder than transgender and gender non-conforming male-to-female individuals. However, more longitudinal studies are needed to gain a more comprehensive understanding of how prevalent eating disorders are within the trans community.

Common Eating Disorders and Symptoms

Anorexia Nervosa

Anorexia nervosa is characterized by drastic weight loss, a preoccupation with food, calories, dieting, and achieving an “ideal” body shape. People with this type of eating disorder may make comments that they feel “fat” or “overweight” even when they are considered to be very underweight by medical standards for people of their height, age, and general stature. It is also common for those with anorexia nervosa to maintain an excessive and often rigid exercise routine that they will stick to no matter the weather, illness, injury or fatigue. Without treatment, individuals with anorexia nervosa at risk of developing long-term health consequences like electrolyte imbalances, cardiac arrest, and even death.

Bulimia Nervosa

Bulimia nervosa is characterized by recurring episodes of binge eating and purging behaviors. This is where someone may experience uncontrollable feelings surrounding food and binge on high-caloric meals, then use purging behaviors to try to compensate for the food they consumed. Common purging behaviors include self-induced vomiting, diuretic and laxative abuse, excessive exercise, and fasting. Those with bulimia nervosa are at risk of developing diabetes, digestive system issues, electrolyte imbalances, and cardiac arrest.

Binge Eating Disorder (BED)

This common eating disorder is very similar to bulimia nervosa in that individuals with binge eating disorder experience recurring binge eating episodes, often eating when they do not feel hungry and eating until they feel shame or disgust. However, with BED, people do not engage in any purging behaviors. This common eating disorder is often linked to obesity and chronic illnesses like diabetes and congestive heart failure.

What Is Gender Dysphoria?

Similar to body dysmorphia, gender dysphoria is a feeling of dissatisfaction and distress concerning the disparity between an individual’s physical appearance and their gender identity. When people who are experiencing gender dysphoria look in the mirror, they are unable to see their bodies as they believe they should be. Additionally, they may have negative feelings concerning their body because society and the people close to them do not see their bodies as they want them to be seen. Either way, these negative feelings of disparity are related to their gender identity.

Many transgender people experience gender dysphoria at some point in their lives. And often their body dissatisfaction is related to specific body parts like their genitalia. Research suggests that transgender people may become more focused on their appearance and society’s beauty ideals than their cisgender peers because they feel an intense pressure to match their gender identity with their outward body shape.  

Gender dysphoria has been identified as a key factor in the development of common eating disorders for many transgender people. Additionally, as transgender and gender non-conforming individuals grow up, they are often subjected to discrimination and bias based on their physical features—especially when they are not consistent with the societal expectations of the sex they were assigned at birth.

Are There Treatment Options Available for People Diagnosed with Bulimia Nervosa and Gender Dysphoria?

Common eating disorders like anorexia nervosa and bulimia nervosa carry the highest mortality rates of any known mental health condition. And the transgender population also has elevated rates of suicide, making the combination of a gender non-conforming or transgender identity and an eating diagnosis two things that should be taken very seriously. While there are no specific treatments designed to help transgender individuals with an eating disorder diagnosis, studies show that early intervention is often key for long-term bulimia nervosa recovery. And although many transgender people are already in therapy as they transition from male-to-female or female-to-male, it is unlikely that their current therapist specializes in eating disorder counseling as well.

Trans People Have Less Access to Care

Because many transgender and gender non-conforming people are subject to prejudice, it can be a difficult task to find access to quality eating disorder treatment. Additionally, many trans individuals have reported that they receive inadequate care from their current healthcare providers due to stigma and prejudice. And many often have limited resources due to discrimination from employers, family, and their local community. All of this can deter transgender individuals from seeking treatment.

However, there are reputable eating disorder treatment options available doe those with BED, anorexia nervosa, bulimia nervosa, and gender dysphoria.

Eating Disorder Treatment for Transgender Individuals

While gender confirmation surgeries can help transgender individuals feel more comfortable with their bodies, they may have little to no effect on a developed eating disorder. The idea behind eating disorder treatment is to help teach people positive coping strategies that will allow them to replace their negative thought patterns and replace them with realistic thoughts.

Cognitive-Behavioral Therapy (CBT)

One of the most effective treatment options for eating disorder treatment is cognitive-behavioral therapy. CBT is the leading evidence-based treatment for eating disorders and makes it possible for medical professionals to take a psycho therapeutic approach to ED recovery. The goal of CBT is to help individuals understand the interaction between their feelings, thoughts, and behaviors. From there, they can begin to develop new coping strategies that will make it possible for them to gradually change negative thought patterns and behaviors.

While CBT is favored by many health professionals in the eating disorder field, other common treatment options include:

  • Acceptance and Commitment Therapy (ACT) — This treatment method takes an action-oriented approach that helps individuals to learn how to stop avoiding and denying their inner emotions and choose to accept these feelings as appropriate responses to different situations. Acceptance and commitment therapy is also used to help treat co-occurring mental health conditions like depression, social anxiety disorder, and obsessive-compulsive disorder.
  • Dialectal Behavior Therapy (DBT) — Originally developed to help treat those with a borderline personality disorder diagnosis, dialectal behavior therapy has proven to be successful in treating a variety of common mental health conditions including eating disorders, substance abuse, post-traumatic stress disorder (PTSD), and more. With dialectal behavior therapy, individuals and their therapists to strike a balance between change and acceptance. Their ultimate aim is to accept themselves as they are, while still being motivated to make positive changes.   

Group Therapy and Outpatient Treatment

For some people, the idea of residential eating disorder treatment doesn’t fit in with their current lifestyle and work commitments. In these cases, participate in group counseling and/or outpatient treatment programs may be the best option. Additionally, as long as an individual has been determined to be medically and mentally stable, they can continue to participate in day or outpatient treatment programs after completing residential treatment.

Contact Oliver-Pyatt Centers Today

For transgender and gender non-conforming individuals who have been diagnosed with an eating disorder, early intervention is essential for long-term recovery. If you or a loved one has been searching for a comprehensive residential eating disorder treatment program or outpatient treatment, at Oliver-Pyatt Centers, we’re here to help. Our friendly and experienced team of medical professionals and counselors are ready to guide you through the recovery process with compassion and understanding.

Interested in learning more about the different eating disorder treatment programs we have available? Please give us a call at 1.866.452.7206 or contact us today for more information regarding our steps to admissions.