Predictors of eating-related psychopathology in transgender and gender nonbinary individuals

Uniacke, Blair; Glasofer, Deborah R.; Devlin, Michael J.; Bockting, Walter; Attia, Evelyn

doi:10.1016/j.eatbeh.2021.101527

Cited by 34 publications

(33 citation statements)

References 44 publications

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“…Within the sample we investigated, all individuals had received gender‐affirming care. Prior studies have shown that affirmation of gender identity can lead to a decrease in or lower disordered eating symptomology (Jones et al, 2018; Testa et al, 2017; Uniacke et al, 2021) and increased body image satisfaction (Owen‐Smith et al, 2018). As such, the occurrence of eating disorders in this medically affirmed population is likely to be lower than in a general population of transgender people.…”

Section: Discussionmentioning

confidence: 99%

“…At the community level, one study leveraged self‐report data from a cross‐sectional study of transgender individuals over the age of 18 years ( n = 452) and found that 7.4% had ever been diagnosed with anorexia nervosa or bulimia nervosa (Diemer et al, 2018). Among these individuals, 55% self‐reported having accessed gender‐affirming medical services, which have been shown to reduce eating disorder symptomology (Ålgars et al, 2012; Jones et al, 2018; Testa et al, 2017; Uniacke et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims

Ferrucci

Lapane

Jesdale

2022

Intl J Eating Disorders

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Objective We estimated the prevalence of diagnosed eating disorders, overall and by select demographics, among commercially insured individuals identified as transgender in a national claims database. Methods From the 2018 IBM® MarketScan® Commercial Database, there were 10,415 people identifiable as transgender based on International Classification of Disease (ICD‐10) codes and procedure codes, specific to gender‐affirming care, from inpatient and outpatient claims. Eating disorders were identified from ICD‐10 codes and included anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, avoidant restrictive feeding and intake disorder, and other specified feeding and eating disorders. We estimated the prevalence of specific eating disorders diagnoses by selecting patient characteristics. Results Of individuals receiving some form of gender‐affirming care, 2.43% (95% confidence interval: 2.14%–2.74%) were diagnosed with an eating disorder: 0.84% anorexia nervosa, 0.36% bulimia nervosa, 0.36% binge eating disorder, 0.15% avoidant restrictive feeding and intake disorder, 0.41% other specified feeding and eating disorders, and 1.37% with an unspecified eating disorder. Among transgender‐identifiable patients aged 12–15 years, 5.60% had an eating disorder diagnosis, whereas 0.52% had an eating disorder diagnosis in patients aged 45–64 years. Discussion In patients identifiable as transgender, with receipt of gender‐affirming care, the prevalence of diagnosed eating disorders was low compared to extant self‐reported data for eating disorder diagnosis in transgender individuals. Among this population, eating disorders were highest in adolescents and young adults. Clinically verified prevalence estimates for eating disorder diagnosis in transgender people with a history of gender‐affirming care warrant further investigation. Public Significance The present study aims to provide clinically validated, contemporary prevalence estimates for diagnosed eating disorders among a medically affirmed population of transgender adults and children in the United States. We report low prevalence of having any eating disorder relative to prevalence estimates reported in prior literature without clinical validation. These findings may be explained by access to affirming care and medical care generally.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims

Ferrucci

Lapane

Jesdale

2022

Intl J Eating Disorders

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“…These results are largely consistent with prior work. For example, youth who feel positively about their SGM identity may experience lower internalized homophobia and/or transphobia, known stressors associated with disordered eating (Calzo et al, 2017; Parker & Harriger, 2020; Uniacke et al, 2021). Additionally, the ability to be open about one's SGM identity could reflect an environment of greater social support, known to reduce the risk of disordered eating among SGM adolescents (Miller & Luk, 2019; Watson et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Sexual and gender minority (SGM) adolescents' disordered eating: Exploring general and SGM‐specific factors

Roberts

Maheux

Watson

et al. 2022

Intl J Eating Disorders

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Objective: Sexual and gender minority (SGM) adolescents disproportionately report disordered eating, yet have primarily been considered under a larger SGM umbrella. The current study 1) compared disordered eating between sexual minority (SM) and gender minority (GM) adolescents; 2) examined how general psychological factors (self-esteem, depression, and stress) and SGM-specific factors (e.g., feelings about SGM identity, access to SGM resources) were associated with disordered eating; and 3) examined whether associations between these factors differed for SM versus GM adolescents.Method: SGM adolescents in the U.S. (N = 8814; 35.0% GM; 43.7% cisgender girls; 66.9% White; M age = 15.6) reported their disordered eating, depressive symptoms, stress, self-esteem, and SGM-related experiences on an anonymous, cross-sectional online survey.Results: GM adolescents exhibited a higher prevalence of clinical threshold disordered eating than SM adolescents. Self-esteem was associated with lower odds of caloric restriction, purging, and binge eating. Depression was associated with higher odds of caloric restriction, diet pill use, purging, laxatives, and binge eating. Stress was associated with higher odds of purging. Associations were stronger for GM adolescents' caloric restriction. Positive feelings about SGM identity were associated with lower odds of caloric restriction, purging, and binge eating, whereas greater stress of "coming out" was associated with higher odds of caloric restriction, purging, and binge eating.Discussion: These results suggest that SGM adolescents' disordered eating is associated with both general psychological factors and unique SGM experiences. Results highlight the importance of considering how the unique experiences of SGM youth may leave them vulnerable to disordered eating behaviors.Public Significance Statement: Sexual and gender minority (SGM) youth are disproportionately affected by disordered eating. The current study found that higher depression and stress, and lower self-esteem, were associated with SGM adolescents' disordered eating. Furthermore, unique SGM experiences, such as stress about coming out, were also associated with eating pathology. Results highlight the importance of considering SGM adolescents' perceptions of their identity and social support.

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“…However, it is worth noting that there were more gender non-binary and transgender patients presenting to the Emergency Department with eating disorders during the pandemic. Previous research suggests an association between eating disorder symptomatology in gender nonbinary and/or transgender individuals who experience minority stress and/or internalized transphobia [ 17 ]. Additional research from residential eating disorder programming also indicates that Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual (2SLGBTQIA+) individuals may experience more lifetime traumas and more eating disorder symptomatology than non-2SLGBTQIA+ clients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Presentation of Patients with Eating Disorders to a Pediatric Quaternary-Level Care Emergency Department During the COVID-19 Pandemic

2022

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Despite an overall decrease in utilization of emergency departments during COVID-19 (Hartnett et al. in MMWR Morb Mortal Wkly Rep. 69(23):699–704, 2020 ), US pediatric emergency departments experienced an increase in mental health visits for children and adolescents (Leeb et al. in MMWR Morb Mortal Wkly Rep. 69(45):1675–80, 2020 ). Simultaneously, individuals with eating disorders reported increasing symptomology (Termorshuizen et al. in Int J Eat Disord. 53(11):1780–90, 2020 ). This study compares Emergency Department utilization at a pediatric quaternary-level care center by patients with eating disorders during the pandemic (March–Dec 2020) vs March-Dec 2019. We hypothesize that there was an increase in presentation of patients with eating disorders. An Informatics for Integrating Biology and the Bedside query of the electronic medical record system identified patients with eating disorder diagnoses per ICD9/ICD10 codes aged 6–23 who presented to the Emergency Department between March 1 st and December 31 st of 2020 and 2019. Subsequent retrospective chart review was carried out. Patients were excluded from analysis if the presenting problem was not directly related to the eating disorder. During March–Dec 2019, 0.581% percent of all patients presented to the Emergency Department due to an eating disorder. During the same time frame in 2020, however, that percentage increased to 1.265%. Statistical significance was corrected using a Benjamini–Hochberg analysis. Despite a 66.5% decline in overall visits to the Emergency Department, the percentage of patients presenting with eating disorders doubled during the pandemic. During the pandemic, the total time spent awaiting placement significantly increased, and the number of patients identifying as transgender and/or nonbinary increased. Our data support the hypothesis that eating disorder presentation increased during the pandemic.

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Predictors of eating-related psychopathology in transgender and gender nonbinary individuals

Cited by 34 publications

References 44 publications

Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims

Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims

Sexual and gender minority (SGM) adolescents' disordered eating: Exploring general and SGM‐specific factors

Presentation of Patients with Eating Disorders to a Pediatric Quaternary-Level Care Emergency Department During the COVID-19 Pandemic

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