Current Psychiatry Reports

, 21:107 | Cite as

Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review

  • Jennifer S. CoelhoEmail author
  • Janet Suen
  • Beth A. Clark
  • Sheila K. Marshall
  • Josie Geller
  • Pei-Yoong Lam
Sex and Gender Issues in Behavioral Health (CN Epperson and L Hantsoo, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Sex and Gender Issues in Behavioral Health


Purpose of Review

This scoping review includes recent literature on eating disorder diagnoses and evaluation of eating disorder symptom presentation among transgender youth (ages 8–25).

Recent Findings

A total of 20 publications from the previous 5 years were identified, including case reports, retrospective chart reviews, and surveys. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth. Similarly, some studies reported transgender youth were more likely to be diagnosed with an eating disorder than cisgender youth, though the proportion of youth with eating disorder diagnoses varied across studies. A consistent theme across case studies was engagement in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression, suggesting that for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress.


Clinical care could be enhanced through establishment of best practices for screening in settings offering eating disorder treatment and gender-affirming care, as well as greater collaboration among these programs. Research is needed to validate eating disorder measures for use with transgender youth and evaluate the effects of eating disorder treatment and gender-affirming medical interventions on the well-being of transgender youth.


Eating disorders Eating pathology Gender dysphoria Transgender Pediatric Young adults 



We would like to thank Melissa Smith MLIS, BA (Reference Librarian at the University of British Columbia) for assistance in developing and consulting on the search methodology. We would also like to thank Pam Narang, PsyD, R. Psych. (British Columbia Children’s Hospital Gender Clinic) for helpful comments on an earlier version of this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there are no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

11920_2019_1097_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 20 kb)


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, et al. The enigma of male eating disorders: a critical review and synthesis. Clin Psychol Rev. 2017;57:1. Scholar
  2. 2.
    Lee JY, Perl L, Rosenthal SM. Care of gender nonconforming/transgender youth. In: Radovick S, Misra M, editors. Pediatr Endocrinol. Springer, Cham. Doi:, 2018.CrossRefGoogle Scholar
  3. 3.
    Surgenor LJ, Fear JL. Eating disorder in a transgendered patient: a case report. Int J Eat Disord. 1998;24:449–52.<449::AID-EAT14>3.0.CO;2-W.CrossRefPubMedGoogle Scholar
  4. 4.
    Hepp U, Milos G. Gender identity disorder and eating disorders. Int J Eat Disord. 2002;32:473–8. Scholar
  5. 5.
    Walters E, Whitehead L. Anorexia nervosa in a young boy with gender identity disorder of childhood: a case report. Clin Child Psychol Psychiatr. 1997;2:563–467. Scholar
  6. 6.
    Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, Diamond DA, et al. Child and adolescents with gender identity disorder referred to a pediatric medical center. Pediatr. 2012;3:418–25. Scholar
  7. 7.
    Khatchadourian K, Amed S, Metzger DL. Clinical management of youth with gender dysphoria in Vancouver. J Pediatr. 2014;164:906–11. Scholar
  8. 8.
    •• Jones BA, Haycraft E, Murjan S, Arcelus J. Body dissatisfaction and disordered eating in trans people: a systematic review of the literature. Int Rev Psychiatr. 2016;28:81–94. A review of the link between gender dysphoria, disordered eating and body dissatisfaction. CrossRefGoogle Scholar
  9. 9.
    McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin N Am. 2016;63:1079–90. Scholar
  10. 10.
    Holt V, Skagerberg E, Dunsford M. Young people with features of gender dysphoria: demographics and associated difficulties. Clin Child Psychol Psychiatr. 2016;21:108–18. Scholar
  11. 11.
    McCann E, Keogh B, Doyle L, Coyne I. The experiences of youth who identify as trans in relation to health and social care needs: a scoping review. Youth Soc. 2017;51:840–64. Scholar
  12. 12.
    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32. Scholar
  13. 13.
    Goldhammer HN, Maston ED, Keuroghlian AS. Addressing eating disorders and body dissatisfaction in sexual and gender minority youth. Am J Prev Med. 2019;56:318–22. Scholar
  14. 14.
    Connolly MD, Zervos MJ, Barone CJ II, Johnson CC, Joseph CL. The mental health of transgender youth: advances in understanding. J Adolesc Health. 2016;59(5):489–95. Scholar
  15. 15.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. Scholar
  16. 16.
    Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme. Version. 2006;1:b92.
  17. 17.
    Becerra-Culqui TA, Liu Y, Nash R, Cromwell L, Flanders WD, Getahun D, et al. Mental health of transgender and gender nonconforming youth compared with their peers. Pediatr. 2018;141(5):e20173845. Scholar
  18. 18.
    Churcher Clarke A, Spiliadis A. ‘Taking the lid off the box’: the value of extended clinical assessment for adolescents presenting with gender identity difficulties. Clin Child Psychol Psychiatr. 2019;24:338–52. Scholar
  19. 19.
    Cibich M, Wade TD. Treating bulimia nervosa in the context of gender dysphoria using 10-session cognitive behavior therapy. Int J Eat Disord. 2019;52:602–6. Scholar
  20. 20.
    Couturier J, Pindiprolu B, Findlay S, Johnson N. Anorexia nervosa and gender dysphoria in two adolescents. Int J Eat Disord. 2015;48:151–5. Scholar
  21. 21.
    • Diemer EW, Grant JD, Munn-Chernoff A, Patterson DA, Duncan AE. Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. J Adolesc Health. 2015;57:144–9. survey of self-reported eating disorder diagnosis and use of compensatory eating behaviors in a large sample of trans and cisgender youth.
  22. 22.
    •• Donaldson AA, Hall A, Neukirch J, Kasper V, Simones S, Gagnon S, et al. Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: a case series. Int J Eat Disord. 2018;51:4675–479. Case series highlighting the importance of collaborative treatment approaches among gender and eating disorder specialists. CrossRefGoogle Scholar
  23. 23.
    • Duffy ME, Henkel KE, Joiner TE. Prevalence of self-injurious thoughts and behaviors in transgender individuals with eating disorders: a national study. J Adolesc Health. 2019;64(4):461–6. Study demonstrating that trans youth with eating disorders are at particularly high risk for self-injury and suicidal thoughts/behaviors.
  24. 24.
    Ewan L, Middleman A, Feldmann J. Treatment of anorexia nervosa in the context of transsexuality: a case report. Int J Eat Disord. 2014;47:112–5. Scholar
  25. 25.
    • Feder S, Isserlin L, Seale E, Hammond N, Norris M. Exploring the association between eating disorders and gender dysphoria in youth. Eat Disord. 2017;25:310–7. A large retrospective chart review that assessed for eating disorder symptoms and diagnoses in trans youth attending a gender diversity clinic.
  26. 26.
    Guss C, Williams D, Reisner S, Austin B, Katz-Wise S. Disordered weight management behaviors, nonprescription steroid use, and weight perception in transgender youth. J Adolesc Health. 2016;60:17–22. Scholar
  27. 27.
    Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child Adolesc Psychiatry Ment Health. 2015;9(1):9. Scholar
  28. 28.
    Nahata L, Quinn GP, Caltabellotta NM, Tishelman AC. Mental health concerns and insurance denials among transgender adolescents. LGBT health. 2017;4(3):188–93. Scholar
  29. 29.
    Peterson CM, Matthews A, Copps-Smith E, Conard LA. Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide Life Threat Behav. 2017;47(4):475–82. Scholar
  30. 30.
    • Ristori J, Fisher A, Castellini G, Sensi C, Cipriani A, Ricca V, et al. Gender dysphoria and anorexia nervosa symptoms in two adolescents. Arch Sex Behav. 2019;27:1–7. Case studies highlighting a reduction in food restriction after gender-affirming medical treatment was provided for two trans youth. CrossRefGoogle Scholar
  31. 31.
    Sevlever M, Meyer-Bahlburg HF. Late-onset transgender identity development of adolescents in psychotherapy for mood and anxiety problems: approach to assessment and treatment. Arch Sex Behav. 2019. Scholar
  32. 32.
    • Strandjord S, Ng H, Rome E. Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: lessons learned. Int J Eat Disord. 2015;48:194–945. A case study highlighting the importance of screening for gender concerns in youth with eating disorders. CrossRefGoogle Scholar
  33. 33.
    Wagner R, Stevens JR. Clinical barriers to effective treatment of eating disorders and co-occurring psychiatric disorders in transgendered individuals. J Psychiatr Pract. 2017;23:284–9. Scholar
  34. 34.
    •• Watson R, Veale J, Saewyc E. Disordered eating behaviors among trans youth: probability profiles from risk and protective factors. Int J Eat Disord. 2017;50:515–22. Examination of predictors of disordered eating behavior in a large sample of transgender youth recruited from a national online survey.CrossRefGoogle Scholar
  35. 35.
    Wright H. ‘Emotional turbulence’: the development of symbolic thinking in the psychotherapeutic treatment of an adolescent girl. J Child Psychother. 2018;44:55–72. Scholar
  36. 36.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.Google Scholar
  37. 37.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub; 2013.Google Scholar
  38. 38.
    Giordano S. Eating yourself away: reflections on the ‘comorbidity’ of eating disorders and gender dysphoria. Clin Ethics. 2017;12:45–53. Scholar
  39. 39.
    Monge MC, Loh M. Medical complications of eating disorders in pediatric patients. Pediatr Ann. 2018;47(6):e238–43. Scholar
  40. 40.
    Golden NH, Katzman DK, Sawyer SM, Ornstein R. Position paper of the society for adolescent health and medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015;56(1):121–5. Scholar
  41. 41.
    Ashley F Gatekeeping hormone replacement therapy for transgender patients is dehumanising. J Med Ethics. 2019:medethics-2018. Doi: Scholar
  42. 42.
    Murray SB, Griffiths S, Mond JM. Evolving eating disorder psychopathology: conceptualising muscularity-oriented disordered eating. Br J Psychiatry. 2016;208(5):414–5. Scholar
  43. 43.
    Thorne N, Witcomb GL, Nieder T, Nixon E, Yip A, Arcelus J. A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary. Int J Transgenderism. 2018;20:241–50. Scholar
  44. 44.
    Keo-Meier CE, Ehrensaft DE. Introduction to the gender affirmative model. American Psychological Association; 2018.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jennifer S. Coelho
    • 1
    • 2
    Email author
  • Janet Suen
    • 1
  • Beth A. Clark
    • 3
  • Sheila K. Marshall
    • 4
    • 5
  • Josie Geller
    • 2
    • 6
  • Pei-Yoong Lam
    • 1
    • 5
  1. 1.Provincial Specialized Eating Disorders Program for Children & AdolescentsBC Children’s HospitalVancouverCanada
  2. 2.Department of PsychiatryUniversity of British ColumbiaVancouverCanada
  3. 3.Allen-Berenson Fellow in Women’s, Gender, and Sexuality StudiesBrandeis UniversityWalthamUSA
  4. 4.School of Social WorkUniversity of British ColumbiaVancouverCanada
  5. 5.Division of Adolescent Health & Medicine, Department of PediatricsUniversity of British ColumbiaVancouverCanada
  6. 6.Eating Disorders Program, St. Paul’s HospitalVancouverCanada

Personalised recommendations