Eating Disorders in Transgender Communities

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The topic of eating disorders in transgender* (see definition in next paragraph) and gender non-conforming individuals has been largely ignored by researchers and clinicians alike. However, grassroots organizations and a game-changing study have recently brought this marginalized population to the forefront.

Within this article, transgender is used to describe people whose gender identity differs from the sex they were assigned at birth (what a doctor marks on someone’s birth certificate).

 Gender identity (or simply ‘gender’) is a person's internal sense of being a man, woman, or someone outside of that gender binary. For transgender people, the sex they were assigned at birth and their internal gender identity do not match. ​Cisgender is the term used to define people who are not transgender or gender non-conforming; people who identify with the gender matching the sex they were assigned at birth (cisgender men were assigned male at birth, cisgender women were assigned female at birth).

Elizabeth W. Diemer, a recent graduate of the Brown School at Washington University in St. Louis, co-authored a revolutionary study of college students and eating disorder prevalence, published in the Journal of Adolescent Health in April 2015.[1] The study collected data from 289,024 students across 223 U.S. universities and focused on the pervasiveness of eating disorder behaviors among LGBTQ (lesbian, gay, bisexual, transgender and queer) students in relation to their cisgender and heterosexual peers.

Diemer and her research team found that transgender students reported struggling with disordered eating at approximately four times the rate of their fellow collegians. Other cisgender LGBQ students also displayed higher rates of eating disorders than heterosexual students.

Unfortunately, it is not eating disorders alone that trans communities face disproportionately.

Research shows[2] they also experience high rates of self-injury, alcohol and substance use, suicide attempts, and other mental health issues.  Theories have proposed these may all be considered maladaptive coping mechanisms stemming from the traumas associated with marginalization and discrimination/violence.

Trans individuals struggle to obtain gender-affirmative healthcare, meaning doctors who honor the need for gender-sensitive care beyond gender-affirming surgeries.  For example, the National Transgender Discrimination Survey (NTDS) of 2013, which compiled the largest amount of data on trans communities in the U.S. to date, demonstrated that 19% of their respondent pool (6,450 trans and gender non-conforming individuals) reported being denied medical care due to their trans status.  Twenty-four percent reported discrimination by doctors, and 48% stated they postponed or did not seek care because they simply could not afford it.[3]

While these findings are deeply problematic and transphobia/discrimination is sadly still pervasive in healthcare fields, there are some signs of potential change.

The significant number of diverse respondents in the collegiate eating disorder study allows us to explore important shifts in the trans eating disorder narrative. Past case studies and research which have focused on limited, binary (representing trans men and women, but not including gender non-conforming/non-binary folks) respondent pools may have oversimplified the presence of eating disorders in trans communities as stemming from/being influenced almost exclusively by trans individuals’ experiences with gender dysphoria and body dysmorphia. In these narratives eating disorders were believed to function primarily as maladaptive attempts to bring one’s physical body more in line with a desired representation/embodiment of one’s authentic gender.

However, instead of focusing solely on trans populations’ complex body dissatisfactions, Diemer and her research team additionally cite systemic oppressions as factors/stressors contributing to the high rates of eating disorders in transgender communities. Eating disorders, besides being brain-based diseases with a genetic component, are complex coping mechanisms and social justice issues incorporating intersecting factors of identities, power, and oppression; they cannot be oversimplified or reduced to a single cause. Diemer and her team state that trans and gender diverse populations may develop eating disorders to cope with systemic mechanisms generally referred to as ‘minority stress… discrimination, violence, victimization, the pressure of concealing one's identity, social alienation, and internalized social stigma.’[4] Trans and gender non-conforming individuals, especially those who also claim other marginalized identities (people of color, disabled folks, immigrant populations and undocumented folks, low-income communities, having an HIV+ status) may develop eating disorders partly as a result of having to cope with intersectional stressors such as transphobia, racism, discrimination, family and spousal rejection, violence and harassment, poverty, lack of employment prospects, etc. Controlling/ritualizing food and exercise can temporarily help those struggling with eating disorders feel a semblance of personal control, a distraction from or self-soothing around the high levels of trauma associated with these oppressive, sometimes violent systems.

The results of Diemer’s study should be a call to action for eating disorder treatment centers, college campuses, healthcare institutions and other systems to accommodate, accept, treat and offer better preventative support and eating disorder screening to trans communities. The study also highlights the gap in available treatment for gender diverse individuals and may have implications for community healing and institutional outreach.  

Trans Folx Fighting Eating Disorders (T-FFED) is an organization that seeks to help bridge this gap through training and outreach to eating disorder treatment professionals, treatment centers, and organizations in gender literacy and community outreach and community-based healing intensives for gender diverse folk. If you are a trans or gender non-conforming person struggling with disordered eating or negative body image issues, please check out our website for resources, We have an online and Los Angeles-based in-person support group; both free and peer-led. We also provide referrals to gender-affirming healthcare professionals.

If you are a healthcare professional or organization interested in learning how you can offer gender-affirmative, culturally competent care to trans communities, please contact Trans Folx Fighting Eating Disorders for a training consultation. Treatment centers (IOP- inpatient) can pledge their allyship and be included in a future referral guide by filling out this survey created by T-FFED and the Alliance for Eating Disorders Awareness. The onus is on all of us to do better, and quickly.


*A note: In this article, I use ‘trans’ in this article as a point of access and understanding to mean a wide swath of diverse gender identities; in the study this article summarizes and analyzes, there was no self-identification option besides ‘transgender,’ nor any accounting for gender non-conformity or non-Western forms of gender diversity (Two-Spirit, hijra, muxe, etc.); thus ‘trans’ is used here as a generalization and stands for a set of identities rather than denoting a specific one. 


[1] Diemer, Elizabeth W.; Grant, Julia D., Ph.D.; Munn-Chernoff, Melissa A., Ph.D.; Patterson, David A., M.S.W., Ph.D.; Duncan, Alexis E., M.P.H., Ph.D. ‘Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students.Journal of Adolescent Health. April 2015: 57, Issue 2: 144-149

[2] McNeil, Jay; Bailey, Louis; Ellis, Sonja; Morton, James, and Regan, Maeve. Trans Mental Health Study, 2012.


Mustankski, Brian S, Ph.D..; Garofalo, Robert, M.D.; and Emerson, Erin M., M.A. Mental Health Disorders, Psychological Distress, and Suicidality in a Diverse Sample of Lesbian, Gay, Bisexual, and Transgender Youths. American Journal of Public Health, 2010.

[3] Grant, Jaime M.; Mottet, Lisa A.; Tanis, Justin; Harrison, Jack; Herman, Jody L.; and Keisling, Mara. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, Executive Summary.

[4] Diemer et al; pg. 148.

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