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

  • Sex and Gender Issues in Behavioral Health (CN Epperson and L Hantsoo, Section Editors)
  • Published:
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Abstract

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.

Summary

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.

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Notes

  1. The study by Duffy et al. [23•] did not report the age range of participants and may have included individuals over the age of 25. However, given that the median age of participants fit the inclusion criteria, the study was included in the review. The study reported by Duffy and colleagues also had an overlapping sample with Diemer and colleagues [21•], as both studies analyzed data from the National College Health Assessment. Duffy et al. [23•] reported on a larger sample of trans youth (n = 678) than the report by Diemer and colleagues [21•], which included 479 trans youth.

References

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

  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. https://doi.org/10.1016/j.cpr.2017.08.001.

    Article  Google Scholar 

  2. Lee JY, Perl L, Rosenthal SM. Care of gender nonconforming/transgender youth. In: Radovick S, Misra M, editors. Pediatr Endocrinol. Springer, Cham. Doi: https://doi.org/10.1007/978-3-319-73782-9_36, 2018.

    Chapter  Google Scholar 

  3. Surgenor LJ, Fear JL. Eating disorder in a transgendered patient: a case report. Int J Eat Disord. 1998;24:449–52. https://doi.org/10.1002/(SICI)1098-108X(199812)24:4<449::AID-EAT14>3.0.CO;2-W.

    Article  CAS  PubMed  Google Scholar 

  4. Hepp U, Milos G. Gender identity disorder and eating disorders. Int J Eat Disord. 2002;32:473–8. https://doi.org/10.1002/eat.10090.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1177/1359104597023011.

    Article  Google Scholar 

  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. https://doi.org/10.1542/peds.2011-0907.

    Article  Google Scholar 

  7. Khatchadourian K, Amed S, Metzger DL. Clinical management of youth with gender dysphoria in Vancouver. J Pediatr. 2014;164:906–11. https://doi.org/10.1016/j.jpeds.2013.10.068.

    Article  CAS  PubMed  Google Scholar 

  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. https://doi.org/10.3109/09540261.2015.1089217. A review of the link between gender dysphoria, disordered eating and body dissatisfaction.

    Article  Google Scholar 

  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. https://doi.org/10.1016/j.pcl.2016.07.008.

    Article  Google Scholar 

  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. https://doi.org/10.1177/1359104514558431.

    Article  Google Scholar 

  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. https://doi.org/10.1177/0044118X17719345.

    Article  Google Scholar 

  12. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32. https://doi.org/10.1080/1364557032000119616.

    Article  Google Scholar 

  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. https://doi.org/10.1016/j.amepre.2018.09.011.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.jadohealth.2016.06.012.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.

    Article  Google Scholar 

  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. https://doi.org/10.13140/2.1.1018.4643.

  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. https://doi.org/10.1542/peds.2017-3845.

    Article  Google Scholar 

  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. https://doi.org/10.1177/1359104518825288.

    Article  Google Scholar 

  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. https://doi.org/10.1002/eat.23068.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1002/eat.22368.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.jadohealth.2015.03.003.A survey of self-reported eating disorder diagnosis and use of compensatory eating behaviors in a large sample of trans and cisgender youth.

  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. https://doi.org/10.1002/eat.22868. Case series highlighting the importance of collaborative treatment approaches among gender and eating disorder specialists.

    Article  Google Scholar 

  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. https://doi.org/10.1016/j.jadohealth.2018.07.016. Study demonstrating that trans youth with eating disorders are at particularly high risk for self-injury and suicidal thoughts/behaviors.

  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. https://doi.org/10.1002/eat.22209.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1080/10640266.2017.1297112. A large retrospective chart review that assessed for eating disorder symptoms and diagnoses in trans youth attending a gender diversity clinic.

  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. https://doi.org/10.1016/j.jadohealth.2016.08.027.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1186/s13034-015-0042-y.

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1089/lgbt.2016.0151.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1111/sltb.12289.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1007/s10508-019-1396-7. Case studies highlighting a reduction in food restriction after gender-affirming medical treatment was provided for two trans youth.

    Article  Google Scholar 

  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. https://doi.org/10.1007/s10508-018-1362-9.

    Article  Google Scholar 

  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. https://doi.org/10.1002/eat.22438. A case study highlighting the importance of screening for gender concerns in youth with eating disorders.

    Article  Google Scholar 

  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. https://doi.org/10.1097/PRA.0000000000000248.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1002/eat.22576. Examination of predictors of disordered eating behavior in a large sample of transgender youth recruited from a national online survey.

    Article  Google Scholar 

  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. https://doi.org/10.1080/0075417X.2018.1440617.

    Article  Google Scholar 

  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. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub; 2013.

  38. Giordano S. Eating yourself away: reflections on the ‘comorbidity’ of eating disorders and gender dysphoria. Clin Ethics. 2017;12:45–53. https://doi.org/10.1177/1477750916661977.

    Article  Google Scholar 

  39. Monge MC, Loh M. Medical complications of eating disorders in pediatric patients. Pediatr Ann. 2018;47(6):e238–43. https://doi.org/10.3928/19382359-20180518-01.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.jadohealth.2014.10.259.

    Article  PubMed  Google Scholar 

  41. Ashley F Gatekeeping hormone replacement therapy for transgender patients is dehumanising. J Med Ethics. 2019:medethics-2018. Doi:https://doi.org/10.1136/medethics-2018-105293.

    Article  Google Scholar 

  42. Murray SB, Griffiths S, Mond JM. Evolving eating disorder psychopathology: conceptualising muscularity-oriented disordered eating. Br J Psychiatry. 2016;208(5):414–5. https://doi.org/10.1192/bjp.bp.115.168427.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1080/15532739.2018.1452660.

    Article  Google Scholar 

  44. Keo-Meier CE, Ehrensaft DE. Introduction to the gender affirmative model. American Psychological Association; 2018.

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Acknowledgments

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.

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Authors and Affiliations

  1. Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children’s Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada

    Jennifer S. Coelho, Janet Suen & Pei-Yoong Lam

  2. Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada

    Jennifer S. Coelho & Josie Geller

  3. Allen-Berenson Fellow in Women’s, Gender, and Sexuality Studies, Brandeis University, Waltham, MA, 02453, USA

    Beth A. Clark

  4. School of Social Work, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada

    Sheila K. Marshall

  5. Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada

    Sheila K. Marshall & Pei-Yoong Lam

  6. Eating Disorders Program, St. Paul’s Hospital, Vancouver, Canada

    Josie Geller

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  1. Jennifer S. Coelho
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Correspondence to Jennifer S. Coelho.

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Coelho, J.S., Suen, J., Clark, B.A. et al. Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Curr Psychiatry Rep 21, 107 (2019). https://doi.org/10.1007/s11920-019-1097-x

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