Abstract
In recent years, researchers discovered that transgender and gender expansive (TGE) individuals had elevated rates of eating disorders when compared with their cisgender peers. TGE clients experience an increased risk for developing eating disorders due to co-occurring gender dysphoria and trauma from gender minority stressors. An inspection of the literature reveals a gap when searching for the trans-masculine adolescent experience of eating disorder treatment, including nominal research targeting TGE clients with eating disorders and minimal exploration of treating these phenomena concurrently. Gender dysphoria creates unique challenges to body image, prompting some TGE clients to use eating disorder behaviors to change their bodies. Gender minority stressors, such as gender-based victimization and identity non-affirmation, increase vulnerability to identity-based traumas. As eating disorder behaviors can be used to cope with trauma, TGE clients are at further risk when experiencing co-occurring identity-based trauma and gender dysphoria. This composite case study seeks to contribute to the literature by providing a description of the therapy provided over the course of two years with a trans-masculine adolescent using restrictive behaviors to change his body to alleviate symptoms of gender dysphoria, as well as to numb against identity-based traumas. Interventions across each treatment phase are grounded in the gender affirmative model, suggesting opportunities to expand this approach to serve TGE clients in traditional eating disorder and trauma therapy.
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References
Ålgars, M., Alanko, K., Santtila, P., & Sandnabba, N. K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders, 20, 300–311. https://doi.org/10.1080/10640266.2012.668482.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Anderson, E. E. (2018). The unfolding and exploration of gender from a gender affirmative perspective. In C. Keo-Meier & D. Ehrensaft (Eds.), The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children (pp. 21–36). Washington, DC: American Psychological Association.
Austin, A., & Craig, S. (2015). Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21–29. https://doi.org/10.1037/a0038642.
Austin, A., Craig, S., & D’Souza, S. (2017). An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness. Professional Psychology Research and Practice. https://doi.org/10.1037/pro0000154.
Baškarada, S. (2014). Qualitative case study guidelines. The Qualitative Report, 19(40), 1–18. Retrieved from https://nsuworks.nova.edu/tqr/vol19/iss40/3.
Barrow, K., & Apostle, D. (2018). Addressing mental health conditions often experienced by transgender and gender expansive children. In C. Keo-Meier & D. Ehrensaft (Eds.), The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children (pp. 71–84). Washington, DC: American Psychological Association.
Butler, J. (1994). Against proper objects. Differences: A Journal of Feminist Cultural Studies, 6, 1–19. Retrieved from https://dukeupress.edu.proxy.libraries.rutgers.edu/.
Conner, M., Johnson, C., & Grogan, S. (2004). Gender, sexuality, body image and eating behaviors. Journal of Health Psychology, 9(4), 505–515. https://doi.org/10.1177/1359105304044034.
Connolly, M. D., Zervos, M. J., Barone, C. J., Johnson, C. C., & Joseph, C. L. (2016). The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health, 59, 489–495. https://doi.org/10.1016/j.adohealth.2016.06.012.
Courturier, J., Pindiproulu, B., Findlay, S., & Johnson, N. (2015). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating disorders, 48(1), 151–155. https://doi.org/10.1002/eat.22368.
dickey, L. M., Singh, A. A., & Walinsky, D. (2017). Treatment of trauma and nonsuicidal self-injury in transgender adults. Psychiatric Clinics of North America, 40, 41–50. https://doi.org/10.1016/j.psc.2016.10.007.
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57, 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003.
Diemer, E. W., White Hughto, J. M., Gordon, A. R., Guss, C., Bryn Austin, S., & Reisner, S. L. (2018). Beyond the binary: Differences in eating disorder prevalence by gender identity in a transgender sample. Transgender Health, 3(1), 17–23. https://doi.org/10.1089/trgh.2017.0043.
Donaldson, A. A., Hall, A., Neukirch, J., Kasper, V., Simones, S., Gagnon, S., et al. (2018). Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series. International Journal of Eating Disorders, 51, 475–479. https://doi.org/10.1002/eat.22868.
Duffy, M. E., Henkel, K. E., & Earnshaw, V. A. (2016). Transgender clients’ experiences of eating disorder treatment. Journal of LGBT Issues in Counseling, 10(3), 136–149. https://doi.org/10.1080/15538605.2016.1177806.
Guss, C. E., William, D. N., Reisner, S. L., Bryn Austin, S., & Katz-Eise, S. L. (2017). Disordered weight management behavior, nonprescription steroid use, and weight perception in transgender youth. Journal of Adolescent Health, 60, 17–22. https://doi.org/10.1017/j.jadohealth.2016.08.027.
Hawkesworth, M. (2019). Gender and political theory: Feminist reckonings. Medford, MA: Polity Press.
Hendricks, M., & Testa, R. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467. https://doi.org/10.1037/a0029597.
Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., et al. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development, 56, 285–290. https://doi.org/10.1159/000355235.
Jäggi, T., Jellestad, L., Corbisiero, S., Schaefer, D. J., Jenewein, J., Schneeberger, A., et al. (2018). Gender minority stress and depressive symptoms in transitioned Swiss transpersons. BioMed Research International. https://doi.org/10.1155/2018/8639263.
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive summary of the report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality.
Jones, B. A., Haycraft, E., & Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature. International Review of Psychiatry, 28(1), 81–94. https://doi.org/10.3109/09540261.2015.1089217.
Keo-Meier, C., & Ehrensaft, D. (2018). Introduction to the gender affirmative model. In C. Keo-Meier & D. Ehrensaft (Eds.), The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children (pp. 3–19). Washington, DC: American Psychological Association.
Kira, I. A., Lewandowski, L., Ashby, J. S., Templin, T., Ramaswamy, V., & Mohanesh, J. (2014). The traumatogenic dynamics of internalized stigma of mental illness among Arab American, Muslim, and refugee clients. Journal of the American Psychiatric Nurses Association, 20(4), 250–266. https://doi.org/10.1177/1078390314542873.
Lorber, J., & Moore, L. J. (2011). Gendered bodies: Feminist perspectives (2nd ed.). New York, NY: Oxford University Press.
Markman, E. R. (2011). Gender identity disorder, the gender binary, and transgender oppression: Implications for ethical social work. Smith College Studies in Social Work, 81(4), 314–327. https://doi.org/10.1080/00377317.2011.616839.
Matsuno, E., & Israel, T. (2018). Psychological interventions promoting resilience among transgender individuals: Transgender resilience intervention model (TRIM). The Counseling Psychology, 46(5), 632–655. https://doi.org/10.1177/0011000018787261.
McClain, Z., & Peebles, R. (2016). Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics of North America, 63(6), 1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008.
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. https://doi.org/10.2307/2137286.
Murray, S. B., Boon, E., & Touyz, W. W. (2013). Diverging eating psychopathology in transgendered eating disorder patients: A report of two case. Eating Disorders, 21, 70–74. https://doi.org/10.1080/10640266.2013.741989.
Nagoshi, J. L., & Brzuzy, S. (2010). Transgender theory: Embodying research and practice. Journal of Women and Social Work, 25(4), 431–443. https://doi.org/10.1177/0886109910384068.
Pleak, R. R. (2009). Formation of transgender identities in adolescence. Journal of Gay & Lesbian Mental Health, 13, 282–291. https://doi.org/10.1080/1935970093165290.
Rabito-Alcón, M. F., & Rodríguez-Molina, J. M. (2016). Body dissatisfaction differences and similarities among people with eating disorders, people with gender dysphoria and university students. Revista de Psicopatología Clínica, 21(2), 97–104. https://doi.org/10.5944/rpcc.vol21.num2.2016.16991.
Reisner, S. L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., et al. (2015). Mental health of transgender youth in are at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health, 56, 275–279. https://doi.org/10.1016/j.jadohealth.2014.10.264.
Roberts, A. L., Rosario, M., Corliss, H. L., Koenen, K. C., & Austin, S. B. (2012). Childhood gender nonconformity: A risk indicator for childhood abuse and post traumatic stress in youth. American Academy of Pediatrics, 129(3), 410–417. https://doi.org/10.1542/peds.2011-1804.
Sallans, R. K. (2012). Second son: Transition toward my destiny, love, and life. Omaha, NE: Scout Publishing.
Seng, J. S., Lopez, W. D., Sperlich, M., Hamama, L., & Reed Meldrum, C. D. (2012). Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality. Social Science & Medicine, 75, 2437–2445. https://doi.org/10.1016/j.soscimed.2012.09.023.
Sennott, S., & Smith, T. (2011). Translating the sex and gender continuums in mental health: A transfeminist approach to client and clinician fears. Journal of Gay & Lesbian Mental Health, 15, 218–234. https://doi.org/10.1080/19359705.2011.553779.
Shalka, T. R. (2019). Trauma and the interpersonal landscape: Developmental tasks of the relational self identity site. Journal of College Student Development, 60(1), 35–51. https://doi.org/10.1353/csd.2019.0002.
Strandjord, S. E., Ng, H., & Rome, E. S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. International Journal of Eating Disorders, 48(7), 942–945.
Testa, R., Michaels, M., Bliss, W., Rogers, M., Balsam, K., & Joiner, T. (2017a). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology, 126(1), 125–136. https://doi.org/10.1037/abn0000234.
Testa, R., Rider, G. N., Haug, N. A., & Balsam, K. (2017b). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology, 36(10), 927–936. https://doi.org/10.1037/heal0000497.
Tishelman, A., & Neumann-Masci, A. (2018). Gender-related trauma. In C. Keo-Meier & D. Ehrensaft (Eds.), The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children (pp. 85–100). Washington, DC: American Psychological Association.
van de Grift, T. C., Cohen-Kettenis, P. T., Elaut, E., De Cuypere, G., Richter-Appelt, H., Haraldsen, I. R., et al. (2016). A network analysis of body satisfaction of people with gender dysphoria. Body Image, 17, 184–190. https://doi.org/10.1017/j.bodyim.2016.04.002.
Velez, B. L., Breslow, A. S., Brewster, M. E., Cox, R., & Foster, A. B. (2016). Building a pantheoretical model of dehumanization with transgender men: Integrating objectification and minority stress theories. Journal of Counseling Psychology, 63(5), 497–508. https://doi.org/10.1037/cou0000136.
Vipond, E. (2015). Resisting transnormativity: Challenging the medicalization and regulation of trans bodies. Theory in Action, 8(2), 21–36. https://doi.org/10.3798/tia.1937-0237.15008.
Vocks, S., Stahn, C., Loenser, K., & Legenbauer, T. (2009). Eating and body image disturbances in male-to-female and female-to-male transsexuals. Archives of Sexual Behavior, 38, 364–377. https://doi.org/10.1007/s10508-008-9424-z.
Wagner, R., & Stevens, J. R. (2017). Clinical barriers to effective treatment of eating disorders and co-occurring psychiatric disorders in transgendered individuals. Journal of Psychiatric Practice, 23(4), 284–289. https://doi.org/10.1097/PRA.0000000000000248.
Watson, K. (2005). Queer theory. Group analysis, 38(1), 67–81. https://doi.org/10.1177/0533316405049369.
Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50(5), 515–522. https://doi.org/10.1002/eat.22627.
Zucker, K. J., Cohen-Kettenis, P. T., Drescher, J., Meyer-Bahlburg, H. F., Pfäfflin, F., & Womack, W. M. (2013). Memo outlining evidence for change for gender identity disorder in the DSM-5. Archives of Sexual Behavior, 42, 901–914. https://doi.org/10.1007/s10508-013-0139-4.
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Protos, K. Restricting the Gendered Body: Understanding the Trans-masculine Adolescent with Anorexia. Clin Soc Work J 49, 380–390 (2021). https://doi.org/10.1007/s10615-020-00758-9
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DOI: https://doi.org/10.1007/s10615-020-00758-9