Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

Abstract

ObjectiveLiterature suggests that transgender, non‐binary, and/or gender expansive (TNG) people are more likely than cisgender peers to experience eating disorders (EDs) and engage in dangerous weight control behaviors. TNG individuals with EDs are dramatically higher risk for self‐harm behaviors, suicidal ideation, and suicidal behaviors than cisgender peers with EDs or TNG peers without EDs, and often engage in ED symptoms/behaviors to alleviate gender dysphoria. Yet, no treatment paradigms have yet been adapted for TNG‐specific ED care. This qualitative study aims to identify stakeholder needs from such care to inform future clinical interventions.MethodsWe elicited patient (n = 12) and mental health clinician (n = 9) stakeholder needs and preferences regarding TNG‐specific ED care. Semi‐structured interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and a behavioral insights framework, EAST, were developed to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. Using a rapid analysis procedure, we produced a descriptive analysis for each group identifying challenges of and opportunities in providing ED care for TNG adults.ResultsStakeholders expressed needs and preferences for TNG‐specific treatment including that it be: (1) TNG‐affirming, weight‐inclusive, trauma‐informed, and anti‐racist; (2) delivered by an interdisciplinary team, including gender‐affirming care clinicians; (3) focused on parsing gender dysphoria from other body image concerns, building distress tolerance, and working toward gender euphoria (rather than body acceptance).DiscussionFuture work is needed exploring ED care delivery models that integrate gender‐affirming care services with mental health care. Such models may improve TNG access to ED treatment and recovery.Public SignificanceTransgender, non‐binary, and/or gender expansive (TNG) experience disproportionately high rates of eating disorders and have unique barriers to accessing care. In individual interviews, TNG adults with eating disorders and mental health clinicians who provide psychotherapy for eating disorders voiced desire for greater availability of TNG‐affirming, weight‐inclusive eating disorder care, integrated with other gender‐affirming care services. This informs future research developing eating disorder care for TNG individuals.

The association between gender‐affirming care and disordered eating in transgender and gender diverse individuals: Exploring appearance congruence and gender‐related motivating factors for weight loss

“…This approach ensures that treatment aligns with individuals' gender identities and promotes holistic well‐being. Building upon these insights, stakeholders in a qualitative study by Goetz and Wolk (2023) expressed specific needs and preferences for TGE‐specific treatment. Treatment should be TGE‐affirming, weight‐inclusive, trauma‐informed, and anti‐racist.…”

Sex Determination in Homo sapiens as a Multi-Step Process: Potential for Development of Variants and Sex Differences in Disease Risk

“…Consequences associated with the stresses of being in those groups often leads to eating disorders [149][150][151][152][153][154][155][156][157][158][159], mental health issues [151], and increased rates of suicides [152,153]. It can also lead to alterations in bone health in transgendered individuals [154][155][156][157].…”