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Risk Factors for Eating Disorders Among Transgender Individuals

People of all gender identities and sexual orientations can develop eating disorders. However, among transgender people, the risk of developing these disorders is increased. Likewise, transgender people who have eating disorders may have a harder time being identified and diagnosed, as well as finding effective treatment services. Below we discuss some of the issues surrounding eating disorders in the transgender community, as well as steps that can be taken to help those who are affected. 

Understanding Gender Identity

The National Eating Disorders Association defines gender identity as a person’s sense of themselves as female, male, both female and male, neither female nor male or another gender altogether. Gender identity is based on an internal perception, rather than genetics or external physical characteristics. 

When an individual is transgender, they have a gender identity that doesn’t match with the sex they were assigned at birth. For example, a transgender male is someone who identifies internally as male but was assigned the female sex at birth when he was born. The opposite of transgender is cisgender, which is a person who has a matching gender identity and assigned sex.

People who are transgender face several issues not common among cisgender individuals. They can be more more prone to bullying, rejection from family and friends, psychological turmoil, violence, and even suicidal thoughts. They are also at a greater risk of developing eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder. 

Risk of Eating Disorders Among Transgender Individuals

Members of the transgender community face many health inequities, including inequities related to the risk of developing an eating disorder. At this time, only a few research studies have been conducted to investigate this issue. However, the results researchers have found so far are alarming at best. For example, one survey of college students found that the risk of a diagnosis of bulimia nervosa or anorexia nervosa was as much as four times greater among transgender students than it was among cisgender students. Likewise, the risk of exhibiting any eating disorder symptoms, such as binging or purging, was two times greater for transgender individuals. Other studies have also found a higher incidence of eating disorders is higher among transgender people. More research is needed to investigate this issue further. 

Risk Factors for Developing an Eating Disorder

Transgender people have all of the same risk factors for developing eating disorders as the general population, but many of these risk factors are exacerbated by their experience as members of the LGBTQ community. Some specific risk factors transgender people face concerning the development of eating disorders include:

  • History of trauma – Like members of the general population, transgender people are more likely to develop eating disorders if they have a history of trauma, especially if that trauma has led to the development of post-traumatic stress disorder. Unfortunately, transgender individuals are typically more likely to experience trauma than others, often in relation to their gender identity. 
  • Lack of support from friends and family – Rejection by friends and family members is a common and traumatic experience for members of the transgender community. Because of this rejection, many transgender people lack a proper support system, which may increase their risk of developing an eating disorder. 
  • Stigma and discrimination – As with rejection by loved ones, stigma and discrimination are also common among members of the transgender community. In many cases, this leads to the internalization of negative beliefs about transgender identity, which may increase the risk of eating disorders and other mental health concerns. The National Eating Disorders Association reports that a study of transgender youth showed an association between high levels of discrimination and the development of eating disorder symptoms.
  • Lack of access to needed health care – Many transgender people lack access to the competent healthcare services they need, possibly because of discrimination, poorly trained healthcare providers or lack of financial resources. Discrimination is one of the most significant issues, with the National Eating Disorder Association reporting that one-third of transgender people can report a negative experience with a healthcare provider in the past year. Regardless of the cause, not receiving needed healthcare can lead to a worsening body image, which raises the risk of developing an eating disorder. 
  • Lack of hormonal therapies or needed surgeries – Because of insurance and/or financial issues, many transgender people are unable to obtain hormone therapies or gender reassignment surgery. As a result, they are more likely to experience extreme body dissatisfaction and develop an eating disorder as a result. 
  • Poor body image – Poor body image is always a risk factor for the development of eating disorders. Unfortunately, poor body image is more common among transgender people. Because these people have a biological sex that does not match their internal perception of their gender identity, they are likely to develop strong negative feelings about their physical appearance. Transgender people may then try to improve the appearance of their bodies by engaging in disordered eating behaviors. 

Help for Transgender People with Eating Disorders

At this time, there are specific steps that can be taken to improve access to treatment for transgender people who have eating disorders. Some recommendations include:

1. Improving access to healthcare. 

Improving access to healthcare for transgender people may reduce the risk of eating disorders developing in the first place. It may also make eating disorder diagnosis and treatment faster and more effective. 

2. Increasing support for people in the transgender community. 

Lack of a support system is both a risk factor for developing an eating disorder, as well as a barrier to getting treatment once eating disorders have already developed. 

3. Improving education among providers who work with members of the transgender community. 

Even when members of the transgender community come into contact with healthcare or other resource providers who are in the right capacity to identify the signs of an eating disorder, their symptoms may go unnoticed because of a lack of training among these individuals. Training providers to recognize the signs of transgender eating disorders may increase detection rates and improve access to needed treatment services.

The Future of Eating Disorders in the Transgender Community

Much of the link between transgender identity and eating disorders are related to inequities that can be addressed or prevented. To address all of these issues, the healthcare and eating disorder treatment community must come together to provide better services for members of this community. Fortunately, as the advocacy for the transgender community continues to grow, better services will likely continue to become available. Also, researchers are investigating the link between transgender identity and eating disorders more in-depth, which will lead to the development of better interventions in the future.

Advice for Friends and Family Members

If you are the friend or family member of a person in the transgender community, it is important to understand the signs of eating disorders so you can intervene if your loved one begins showing symptoms. It is also important to understand how to best support the individual to ensure the effectiveness of the intervention. 

Some of the signs of transgender eating disorders include: 

  • Preoccupation with body image, losing weight and/or preventing weight gain
  • Excessive exercise
  • Fear or avoidance of eating in front of others
  • Hoarding or stealing food
  • Extreme restriction of food intake
  • Elimination of entire categories or types of food
  • Episodes of binge eating
  • Complaints of stomach pain or other gastrointestinal problems 
  • Disappearing to the bathroom during or after meals
  • Signs of purging, such as calluses on the knuckles or damage to the teeth and gums

These are just some of the symptoms that may appear in someone who has an eating disorder. Likewise, someone who has an eating disorder is unlikely to exhibit all of these symptoms at the same time. The specific symptoms that appear are likely to depend on the type of eating disorder, as well as the individual’s unique characteristics. 

If you notice the signs of an eating disorder in a transgender loved one, you need to take action quickly. When an eating disorder is left untreated, the individual’s condition is likely to continually worsen over time. The first step in taking action involves approaching your transgender loved one about their symptoms. Keep in mind that many transgender people with eating disorders will be embarrassed by their symptoms and condition, making them resistant to admit that a problem exists. Remember to approach the individual as calmly and lovingly as possible, and avoid any sign of anger or disappointment. If your loved one is currently resistant to the idea of treatment, remind them that you are ready to provide support at any time if they change their mind. You can also contact an eating disorder treatment center like Monte Nido for more resources or assistance.

Seeking Treatment for an Eating Disorder

If you or a loved one is a transgender individual suffering from an eating disorder, you need to seek treatment as soon as possible. However, it is important to note that not all eating disorder treatment programs are created equal, and some programs will be better equipped to provide the customized treatment services you need. Transgender patients require specialized treatment services designed to address their unique experiences as a transgender community member. These individuals often have underlying factors that differ from members of the general population, and these factors must be addressed to give the individual the best possible chance of achieving a full, lasting recovery.

To find an appropriate treatment program, begin by investigating all available options. Be sure to inquire about the background of the professionals providing treatment, as well as the availability of services specialized for members of the LGBTQ community. Depending on your situation, you may need to consider logistical factors such as location and cost as well. If you are seeking treatment for a transgender loved one, remember to include this individual in the process of selecting a program, as doing so will make treatment compliance more likely. 

Transgender Eating Disorder Treatment at Monte Nido

Monte Nido is a nationwide leader in the treatment of eating disorders. Our facilities proudly accept all patients, including transgender individuals. We understand that living as a transgender person is a unique experience, and we tailor our programs to accommodate this experience among transgender patients. Monte Nido offers locations all across the United States for the convenience of patients. Our facilities offer both inpatient programs and day treatment to meet the needs of different people. We also offer medical and nursing care for patients who have experienced physical complications because of their eating disorder. 

If you or someone you love is experiencing the symptoms of an eating disorder, please contact Monte Nido today to learn more about our treatment programs. 


Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.