Beyond the Binary: Gender diversity and its added complexity in eating disorders

Julie Foster, DO serves as both Regional Outreach Manager and Inclusion Specialist in the Pacific Northwest Region. Her role ensures the Monte Nido programs are deeply connected in the community while advocating for the needs of marginalized populations within the Monte Nido & Affiliates family as well. In part two of Julie’s series, she continues to share gender diversity and its added complexity in eating disorder treatment. 

While the actual diagnosis of an eating disorder in a gender diverse person is the same as in a cisgender person, they can be rooted in different systems and in response to different life experiences. For example, the diagnosis of anorexia nervosa has the same meaning of intentional caloric restriction, intense fear about gaining weight, and a disturbance in the way the body is perceived whether for a cis or transgender person. But please consider the following.

Transgender and gender diverse people are exposed to the same intense diet culture and thin ideal as anyone else. We are all subjected to messages about what a female body should be, what is an acceptable form of male. We can easily recite the beauty standards as they apply to the cis gender model of males and females. But while adhering to cultural norms such as obsession with thinness can affect us all, there can be different driving forces and consequences for failing to comply for gender non-conforming folks.

For example, a transgender person may intentionally restrict food or even exercise in a very specific way in order to more safely navigate the world by conforming to what people expect for male and female bodies. This is separate from wanting to be thin for the sake of thinness. It is wanting to be thin for the sake of self, safety and acceptance. Remember from the first article that gender diverse folks face a much higher risk of personal violence and daily micro-aggressions. This can be from simply trying to access a restroom or walking down the street. So the need to conform often by thinness or certain body shapes can be a matter of life and death.

Also, the life experience of living in a body that isn’t congruent with what you believe about yourself is incredibly painful and baffling at times. Looking in the mirror to find a reflection that isn’t your true reflection can leave a person searching for any tool that might bring their body into alignment with their identity. For some this may be using clothing, mannerisms, and social activities that contribute to feeling like oneself. But for some changing the body itself becomes necessary. And for some, including those without access to gender-affirming medical care, the use of eating disorder behaviors can become a means to that end. Unfortunately, eating disorders are incredibly serious and can be life-threatening. So our gender diverse clients need to be able to access treatment with providers and organizations who at least acknowledge and understand to some extent the complexity that comes with gender diversity.

It’s also imperative that we remember the great deal of pressure and threat that comes with a life as a gender minority. This can look like increased risk of violence by strangers, family, and intimate partners. This can look like discrimination at work, decreased access to jobs or promotions based on gender identity. It can absolutely include rejection from family, and increased risk of housing insecurity. These are all forms of transphobia. But life as a gender diverse person can also hold a great deal of internalized transphobia, and this can be even more damaging.

I have my own history of an eating disorder. And as I come to understand the complexity of my gender, I can now see how I used my eating disorder behaviors to quiet the constant undercurrent of anxiety. I used my bingeing behaviors to sooth what felt intolerable. I too had cycles of restriction that manipulated my body for certain periods of time to be more in alignment with who I know myself to be. I’ve used food to dull the hypervigilance and constant feeling of “not enough-ness, not safe-ness” that quietly ran in the background.

My journey is my own, but it is not uncommon. It is in fact shared quite extensively within the transgender and gender non-conforming community. So this brings the imperative for all humans to educate themselves and expand their awareness of gender minorities. It also brings an imperative for treatment professionals, both in private practice and in organizations, to educate themselves and advocate for affirming treatment cultures, spaces, and programs. I’m extremely proud of the work that’s being done at Monte Nido as we invest to ensure our teams have specific training designed to increase our gender fluency, our gender understanding, and our gender compassion. By doing so we invest in creating spaces where all humans are able to themselves, to be seen as themselves and to develop their resiliency on the path of recovery.

To read part one of Julie’s series, click HERE.

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