Abstract
The co-occurrence of gender dysphoria and anorexia nervosa has been described in the scientific literature. This paper presents two adolescents with gender dysphoria and pathological eating behaviors and questions with longitudinal observations the clinical meaning of anorexia nervosa symptoms (e.g., restricting eating behaviors and fear of gaining weight) in adolescents with gender dysphoria. Both received psychological evaluations at different times: at first admission to the gender dysphoria clinic (T0) and 6 months after starting treatment with gonadotropin-releasing analogues (GnRHa; T1). In both cases, treatment with GnRHa not only improved psychological functioning, but also resolved pathological eating behaviors. In fact, both adolescents reported quick restoring of healthy food habits with restricting eating behaviors as well as intensive exercise no longer needed after treatment with GnRHa. Therefore, pathological eating behaviors (e.g., food avoidance and weight loss) could be assessed as a dysfunctional coping strategy adopted to gain control over a body developing in an unwanted direction and to block irreversible physical pubertal changes. This psychopathological conceptualization of pathological eating behaviors in adolescents with gender dysphoria stresses the importance of providing, in selected cases, early medical intervention such as pubertal suppression with GnRHa. Mental health professionals should therefore perform a specific and detailed assessment on gender identity within the evaluation of apparent eating disorders in adolescents. Restrictive eating behaviors as well as the intense fear of gaining weight or of becoming fat may, in fact, be considered secondary to a gender dysphoria diagnosis instead of anorexia nervosa symptoms.
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References
Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Department of Psychiatry, University of Vermont.
Ålgars, M., Alanko, K., Santtila, P., & Sandnabba, N. K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders, 20, 300–311.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Arlington, VA: American Psychiatric Press.
Bandini, E., Fisher, A. D., Castellini, G., Lo Sauro, C., Lelli, L., Meriggiola, M. C., … Ricca, V. (2013). Gender identity disorder and eating disorders: Similarities and differences in terms of body uneasiness. Journal of Sexual Medicine, 10, 1012–1023.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.
Beck, A. T., Steer, R. A., & Brown, G. (1996). Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation.
Cacciari, E., Milani, S., Balsamo, A., Spada, E., Bona, G., Cavallo, L., … Cicognani, A. (2006). Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). Journal of Endocrinological Investigation, 29, 581–593.
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., … Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232.
Costa, R., Dunsford, M., Skagerberg, E., Holt, V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 2206–2214.
Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N. (2015). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating Disorders, 48, 151–155.
Cuzzolaro, M., Vetrone, G., Marano, G., & Garfinkel, P. (2006). The Body Uneasiness Test (BUT): Development and validation of a new body image assessment scale. Eating and Weight Disorders, 11, 1–13.
de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696–704.
de Vries, A. L., Steensma, T. D., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.
Deogracias, J. J., Johnson, L. L., Meyer-Bahlburg, H. F. L., Kessler, S. J., Schober, J. M., & Zucker, K. J. (2007). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Journal of Sex Research, 44, 370–379.
Ewan, L. A., Middleman, A. B., & Feldmann, J. (2014). Treatment of anorexia nervosa in the context of transsexuality: A case report. International Journal of Eating Disorders, 47, 112–115.
Feder, S., Isserlin, L., Seale, E., Hammond, N., & Norris, M. L. (2017). Exploring the association between eating disorders and gender dysphoria in youth. Eating Disorders, 25, 310–317.
Fisher, A. D., Bandini, E., Casale, H., Ferruccio, N., Meriggiola, M. C., Gualerzi, A., … Maggi, M. (2013). Sociodemographic and clinical features of gender identity disorder: An Italian multicentric evaluation. Journal of Sexual Medicine, 10, 408–419.
Fisher, A. D., Castellini, G., Bandini, E., Casale, H., Fanni, E., Benni, L., … Rellini, A. H. (2014a). Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. Journal of Sexual Medicine, 11, 709–719.
Fisher, A. D., Castellini, G., Ristori, J., Casale, H., Cassioli, E., Sensi, C., … Maggi, M. (2016). Cross-sex hormone treatment and psychobiological changes in transsexual persons: Two-year follow-up data. Journal of Clinical Endocrinology & Metabolism, 101, 4260–4269.
Fisher, A. D., Ristori, J., Bandini, E., Giordano, S., Mosconi, M., Jannini, E., … Maggi, M. (2014b). Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG. Journal of Endocrinological Investigation, 37, 675–687.
Fisher, A. D., Ristori, J., Castellini, G., Sensi, C., Cassioli, E., Prunas, A., … Maggi, M. (2017). Psychological characteristics of Italian gender dysphoric adolescents: A case–control study. Journal of Endocrinological Investigation, 40, 953–965.
Giordano, S. (2012). Children with gender identity disorder: A clinical, ethical, and legal analysis. New York: Routledge.
Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L. J., Hannema, S. E., Meyer, W. J., Murad, M. H., … T’Sjoen, G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 102, 3869–3903.
Hepp, U., & Milos, G. (2002). Gender identity disorder and eating disorders. International Journal of Eating Disorders, 32, 473–478.
Hepp, U., Milos, G., & Braun-Scharm, H. (2004). Gender identity disorder and anorexia nervosa in male monozygotic twins. International Journal of Eating Disorders, 35, 239–243.
Jones, B. A., Haycraft, E., Murjan, S., & Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature. International Review of Psychiatry, 28, 81–94.
Osman, A., Barrios, F. X., Panak, W. F., Osman, J. R., Hoffman, J., & Hammer, R. (1994). Validation of the Multi-Attitude Suicide Tendency Scale in adolescent samples. Journal of Clinical Psychology, 50, 847–855.
Spack, N. P. (2013). Management of transgenderism. Journal of the American Medical Association, 309, 478–484.
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, 942–945.
Turan, Ş., Poyraz, C. A., & Duran, A. (2015). Prolonged anorexia nervosa associated with female-to-male gender dysphoria: A case report. Eating Behaviors, 18, 54–56.
Turan, Ş., Aksoy Poyraz, C., Usta Sağlam, N. G., Demirel, Ö. F., Haliloğlu, Ö., Kadıoğlu, P., & Duran, A. (2018). Alteration in body uneasiness, eating attitudes, and psychopatology before and after cross-sex hormonal treatment in patients with female-to-male gender dysphoria. Archives of Sexual Behavior, 47, 2349–2361.
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.
Witcomb, G. L., Bouman, W. P., Brewin, N., Richards, C., Fernandez-Aranda, F., & Arcelus, J. (2015). Body image dissatisfaction and eating-related psychopathology in trans individuals: A matched control study. European Eating Disorders Review, 23, 287–293.
Yildiz, B. O., Bolour, S., Woods, K., Moore, A., & Azziz, R. (2010). Visually scoring hirsutism. Human Reproduction Update, 16, 51–64.
Zachmann, M., Prader, A., Kind, H. P., Hafliger, H., & Budliger, H. (1974). Testicular volume during adolescence. Cross-sectional and longitudinal studies. Helvetica Paediatrica Acta, 29, 61–72.
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Ristori, J., Fisher, A.D., Castellini, G. et al. Gender Dysphoria and Anorexia Nervosa Symptoms in Two Adolescents. Arch Sex Behav 48, 1625–1631 (2019). https://doi.org/10.1007/s10508-019-1396-7
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DOI: https://doi.org/10.1007/s10508-019-1396-7