Gender Differences in Symptom Presentation and Treatment Outcome in Children and Youths With Eating Disorders

Abstract

Background. To address the gaps in the literature examining eating disorders among males and gender minority youths, a prospective study was designed to assess gender differences in eating disorder symptom presentation and outcomes. Muscularity concerns may be particularly relevant for male youths with eating disorders, and were included in assessment of eating disorder symptom presentation. Methods. All male youths who presented for specialized eating disorder treatment at one of two sites were invited to participate, along with a group of matched females, and all youths who did not identify with the sex assigned to them at birth. Youths completed measures of eating disorder symptoms, including muscularity concerns, and other psychiatric symptoms at baseline and end of treatment.Results. A total of 27 males, 28 females and 6 trans youths took part in the study. At baseline, Kruskal-Wallis tests demonstrated that trans youths reported higher scores than cisgender male and female youths on measures of eating pathology (Eating Disorder Examination – Questionnaire (EDE-Q) and the body fat subscale of the Male Body Attitudes Scale (MBAS)). These analyses demonstrated that there were no differences between cisgender male and female youths on eating disorder symptoms at baseline. However, repeated measures ANOVA demonstrated that males had greater decreases than did females in eating pathology at discharge than did females, based on self-reported scores on the EDE-Q, MBAS, and Body Change Inventory. Conclusions. Gender differences in eating pathology appeared at baseline, with trans youths reporting higher levels of eating pathology than cisgender youths, though no differences between cisgender males and females emerged at baseline for eating disorder symptom presentation. Contrary to expectations, there were no gender differences in measures of muscularity concerns. Males demonstrated greater eating disorder symptom improvements than females, suggesting that male adolescents may have better treatment outcomes than females in some domains.

Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals

“…In contrast with two previous studies, one in transgender youth and one in LGBT adults, and in contrast to our original hypothesis, we did not find higher ED symptom severity for TNB patients on admission to treatment (Coelho et al, 2021; Mensinger et al, 2020). Due to limitations of sample size, this study was only able to detect larger differences in symptom severity, and thus, smaller differences may have been present.…”

“…Thus, it is also possible that, as our data suggest, ED severity is similar across gender modalities at the time of presentation to a higher level of care. There were significant improvements in ED symptoms by time of discharge for TNB patients that was comparable to that of their cisgender peers, which aligns with previous studies that included TNB individuals but were underpowered to report on them as a distinct cohort (Coelho et al, 2021; Donahue et al, 2020). Previous qualitative research has raised concerns that standard ED treatment may be ineffective for TNB individuals (Duffy et al, 2016).…”

Treatment experiences of male and female youths with eating disorders

“…Limitations of the study include the potential for bias in the youths who agreed to participate in an interview. Less than one third of participants who were recruited for the prospective study (Coelho et al, 2021b) took part in the interview. A larger sample of participants for the interview was added by inviting individuals to participate in the interview only.…”

“…Participants were recruited from two study sites: British Columbia (BC) Children's Hospital Provincial Specialized Eating Disorders Program for Children and Adolescents, and Looking Glass Residence. Participants were recruited as part of a prospective study examining gender differences in treatment outcomes among youths with eating disorders (Coelho et al, 2021b). All cisgender male youths who presented for treatment were invited to participate.…”