With growing visibility of diverse gender identities and communities, it is necessary for clinicians involved in eating disorder prevention, screening, and treatment to create affirming spaces for transgender and gender non-binary (T/GNB) patients and clients. Further underscoring this need, there is mounting evidence that T/GNB populations are at 2–4 times greater risk of experiencing eating disorder symptoms compared to their cisgender (i.e., non-transgender) counterparts. Although research on the risk and protective factors underlying these health inequities is growing, more epidemiologic and clinical research is urgently needed. This chapter synthesizes the current state of the science and provides recommendations for clinicians at all levels of familiarity with T/GNB populations, including clinicians who are just beginning to think about gender diversity in their practice as well as those who have expertise in this area and wish to identify next steps for their clinical care, research, and/or advocacy in the field.
- Gender identity
- Gender diversity
- Gender affirmation
- Sociocultural influences
- Eating disorder
This is a preview of subscription content, access via your institution.
Tax calculation will be finalised at checkout
Purchases are for personal use onlyLearn about institutional subscriptions
Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? Los Angeles: The Williams Institute; 2016.
Herman JL, Flores AR, Brown TN, Wilson BD, Conron KJ. Age of individuals who identify as transgender in the United States. Los Angeles: The Williams Institute; 2017.
Feinberg L. Stone butch blues: a novel. Ithaca: Firebrand Books; 1993.
Mock J. Redefining realness: my path to womanhood, identity, love & so much more. In: First Atria books hardcover edition. New York: Atria Books; 2014.
Serano J. Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity. Seal Press. Emeryville, CA. 2007.
James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality; 2016.
Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, Holland CE, Max R, Baral SD. Global health burden and needs of transgender populations: a review. Lancet. 2016;388:412–36.
Meyerowitz JJ. How sex changed: a history of transsexuality in the United States. Cambridge, MA: Harvard Univ. Press; 2009.
Daphne S, Meredith AJ. The last time I wore a dress. New York: Riverhead Books; 1998.
Erickson-Schroth L, editor. Trans bodies, trans selves: a resource for the transgender community. Trans bodies, trans selves: a resource for the transgender community xxi, 649–xxi, 649; 2014.
Turban JL, Ehrensaft D. Research review: gender identity in youth: treatment paradigms and controversies. J Child Psychol Psychiatry. 2018;59:1228–43.
Cavanaugh T, Hopwood R, Lambert C. Informed consent in the medical care of transgender and gender-nonconforming patients. AMA J Ethics. 2016. https://doi.org/10.1001/journalofethics.2016.18.11.sect1-1611.
Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991;43:1241–99.
Wesp LM, Malcoe LH, Elliott A, Poteat T. Intersectionality research for transgender health justice: a theory-driven conceptual framework for structural analysis of transgender health inequities. Transgend Health. 2019;4:287–96.
Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. J Adolesc Health. 2015. https://doi.org/10.1016/j.jadohealth.2015.03.003.
Guss CE, Williams DN, Reisner SL, Austin SB, Katz-Wise SL. Disordered weight management behaviors, nonprescription steroid use, and weight perception in transgender youth. J Adolesc Health. 2017;60:17–22.
Brown GR, Jones KT. Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the veterans health administration: a case-control study. LGBT Health. 2016;3:122–31.
Lipson SK, Sonneville KR. Eating disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities. Eat Behav. 2017;24:81–8.
Diemer EW, White Hughto JM, Gordon AR, Guss C, Austin SB, Reisner SL. Beyond the binary: differences in eating disorder prevalence by gender identity in a transgender sample. Transgend Health. 2018. https://doi.org/10.1089/trgh.2017.0043.
Avila JT, Golden NH, Aye T. Eating disorder screening in transgender youth. J Adolesc Health. 2019. https://doi.org/10.1016/j.jadohealth.2019.06.011.
Austin SB, Nelson LA, Birkett MA, Calzo JP, Everett B. Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students. Am J Public Health. 2013;103:e16–22.
Gordon AR, Austin SB, Krieger N, White Hughto JM, Reisner SL. “I have to constantly prove to myself, to people, that I fit the bill”: perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women. Soc Sci Med. 2016;165:141–9.
Thompson JK. Exacting beauty: theory, assessment, and treatment of body image disturbance. 1st ed. Washington, DC: American Psychological Association; 1999.
McCabe MP, Ricciardelli LA. Sociocultural influences on body image and body changes among adolescent boys and girls. J Soc Psychol. 2003. https://doi.org/10.1080/00224540309598428.
Gordon AR, Austin SB, Pantalone DW, Baker AM, Eiduson R, Rodgers R. Appearance ideals and eating disorders risk among LGBTQ college students: the being ourselves living in diverse bodies (BOLD) study. J Adolesc Health. 2019. https://doi.org/10.1016/j.jadohealth.2018.10.096.
Brewster ME, Velez BL, Breslow AS, Geiger EF. Unpacking body image concerns and disordered eating for transgender women: the roles of sexual objectification and minority stress. J Couns Psychol. 2019;66:131–42.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.
Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012;43:460.
Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298:1685–7.
Copeland WE, Bulik CM, Zucker N, Wolke D, Lereya ST, Costello EJ. Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis. Int J Eat Disord. 2015. https://doi.org/10.1002/eat.22459.
Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. J Adolesc Health. 2014;54:724–9.
McGuire JK, Doty JL, Catalpa JM, Ola C. Body image in transgender young people: findings from a qualitative, community based study. Body Image. 2016;18:96–107.
Watson RJ, Veale JF, Saewyc EM. Disordered eating behaviors among transgender youth: probability profiles from risk and protective factors. Int J Eat Disord. 2017;50:515–22.
Velez BL, Breslow AS, Brewster ME, Cox R, Foster AB. Building a pantheoretical model of dehumanization with transgender men: integrating objectification and minority stress theories. J Couns Psychol. 2016. https://doi.org/10.1037/cou0000136.
Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013. https://doi.org/10.1007/s11199-012-0216-5.
Glynn TR, Gamarel KE, Kahler CW, Iwamoto M, Operario D, Nemoto T. The role of gender affirmation in psychological well-being among transgender women. Psychol Sex Orientat Gend Divers. 2016;3:336–44.
Testa RJ, Rider GN, Haug NA, Balsam KF. Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychol. 2017;36:927–36.
Jones BA, Haycraft E, Bouman WP, Brewin N, Claes L, Arcelus J. Risk factors for eating disorder psychopathology within the treatment seeking transgender population: the role of cross-sex hormone treatment. Eur Eat Disord Rev. 2018. https://doi.org/10.1002/erv.2576.
Van De Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, De Cuypere G, Richter-Appelt H, Kreukels BPC. Effects of medical interventions on gender dysphoria and body image: a follow-up study. Psychosom Med. 2017. https://doi.org/10.1097/PSY.0000000000000465.
Vance SR, Mesheriakova VV. Documentation of gender identity in an adolescent and young adult clinic. J Adolesc Health. 2017. https://doi.org/10.1016/j.jadohealth.2016.10.018.
Rullo JE, Foxen JL, Griffin JM, Geske JR, Gonzalez CA, Faubion SS, van Ryn M Patient acceptance of sexual orientation and gender identity questions on intake forms in outpatient clinics: a pragmatic randomized multisite trial. Health Serv Res. 2018. https://doi.org/10.1111/1475-6773.12843.
Deutsch MB, Green J, Keatley JA, Mayer G, Hastings J, Hall AM. Electronic medical records and the transgender patient: recommendations from the world professional association for transgender health EMR working group. J Am Med Inform Assoc. 2013. https://doi.org/10.1136/amiajnl-2012-001472.
Rosendale N, Goldman S, Ortiz GM, Haber LA. Acute clinical care for transgender patients: a review. JAMA Intern Med. 2018. https://doi.org/10.1001/jamainternmed.2018.4179.
Aardoom JJ, Dingemans AE, Slof Op’t Landt MCT, Van Furth EF. Norms and discriminative validity of the eating disorder examination questionnaire (EDE-Q). Eat Behav. 2012. https://doi.org/10.1016/j.eatbeh.2012.09.002.
Garner DM, Olmstead MP, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord. 1983. https://doi.org/10.1002/1098-108X(198321)2:2<15::AID-EAT2260020203>3.0.CO;2-6.
Nagata JM, Murray SB, Compte EJ, Pak EH, Schauer R, Flentje A, Capriotti MR, Lubensky ME, Lunn MR, Obedin-Maliver J. Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women. Eat Behav. 2020;37:101381.
Lock J, La Via MC. Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry. 2015. https://doi.org/10.1016/j.jaac.2015.01.018.
Klaver M, Dekker MJHJ, de Mutsert R, Twisk JWR, den Heijer M. Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: a meta-analysis. Andrologia. 2017. https://doi.org/10.1111/and.12660.
Carswell JM, Roberts SA. Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents. Transgender Health. 2017. https://doi.org/10.1089/trgh.2017.0021.
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T’Sjoen GG. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:3869–903.
Katzman DK, Golden NH. Feeding and eating disorders. In: Neinstein LS, Katzman DK, Callahan ST, Gordon CM, Joffe A, Rickert VI, editors. Adolescent and young adult health care: a practical guide. 6th ed. Wolters Kluwer; Philadelphia, PA. 2017. p. 301–310.
Donaldson AA, Hall A, Neukirch J, Kasper V, Simones S, Gagnon S, Reich S, Forcier M. Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: a case series. Int J Eat Disord. 2018;51:475–9.
Golden NH, Katzman DK, Sawyer SM, Ornstein RM. Position paper of the society for adolescent health and medicine: medical management of restrictive eating disorders in adolescents and young adults references. J Adolesc Health. 2015. https://doi.org/10.1016/j.jadohealth.2014.10.259.
Carswell JM, Roberts SA. Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents. Transgend Health. 2017. https://doi.org/10.1089/trgh.2017.0021.
Kidd KM, Sequeira GM, Dhar CP, Montano GT, Witchel SF, Rofey D. Gendered body mass index percentile charts and transgender youth: making the case to change charts. Transgend Health. 2019. https://doi.org/10.1089/trgh.2019.0016.
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012. https://doi.org/10.1080/15532739.2011.700873.
Ewan LA, Middleman AB, Feldmann J. Treatment of anorexia nervosa in the context of transsexuality: a case report. Int J Eat Disord. 2014. https://doi.org/10.1002/eat.22209.
Strandjord SE, Ng H, Rome ES. Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: lessons learned. Int J Eat Disord. 2015. https://doi.org/10.1002/eat.22438.
Ålgars M, Alanko K, Santtila P, Sandnabba NK. Disordered eating and gender identity disorder: a qualitative study. Eat Disord. 2012. https://doi.org/10.1080/10640266.2012.668482.
Martha P, Inwards-Breland DJ, Watson L, Lara H. Bodies beyond the binary: developing a collaborative gender affirming approach to eating disorder management in gender nonconforming youth (conference presentation). Society for Adolescent Health and Medicine; 2019.
Bushell J. How current eating disorder discourse fails the LGBTQ community. And how we can change that. In: Huffington Post (blog). 2017. https://www.huffingtonpost.com/entry/how-current-eating-disorder-discourse-fails-the-lgbtq_us_5975e0fce4b0f1feb89b44e7.
Perry M, Watson L, Hayden L, Inwards-Breland D. Using body neutrality to inform eating disorder management in a gender diverse world. Lancet Child Adolesc Health. 2019;3:597–8.
Duffy ME, Henkel KE, Earnshaw VA. Transgender clients’ experiences of eating disorder treatment. J LGBT Issues Couns. 2016;10:136–49.
Walton HM, Baker SL. Treating transgender individuals in inpatient and residential mental health settings. Cogn Behav Pract. 2019. https://doi.org/10.1016/j.cbpra.2017.09.006.
Lyons T, Shannon K, Pierre L, Small W, Krüsi A, Kerr T. A qualitative study of transgender individuals’ experiences in residential addiction treatment settings: stigma and inclusivity. Subst Abuse Treat Prev Policy. 2015. https://doi.org/10.1186/s13011-015-0015-4.
Editors and Affiliations
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Gordon, A.R., Moore, L.B., Guss, C. (2021). Eating Disorders Among Transgender and Gender Non-binary People. In: Nagata, J.M., Brown, T.A., Murray, S.B., Lavender, J.M. (eds) Eating Disorders in Boys and Men. Springer, Cham. https://doi.org/10.1007/978-3-030-67127-3_18
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-67126-6
Online ISBN: 978-3-030-67127-3