Eating Disorder Prevalence Among Transgender People

The following fact sheet includes details that may be triggering to some readers. 

Research into eating disorders in transgender and gender non-conforming people is very limited, however the studies that have been completed do suggest a greater incidence of eating disorders in this group than in the general population. The available findings suggest that transgender people are more likely than cisgender people to have been diagnosed with an eating disorder (Diemer et.al., 2018) or to engage in disordered eating behaviours (Parker and Harriger, 2020). 

A 2018 survey of LGBTQ+ people found that over 50% had been diagnosed with an eating disorder, including 71% percent of the transgender participants who identified as straight (The Trevor Project, 2018).

In a survey of over 300,000 US college students, 18% of the transgender survey participants reported having an eating disorder in the last year, and of this group 74.8% had also attempted suicide in the last year (Duffy, Henkel, Joiner, 2018). These are sobering statistics and demonstrate how serious and potentially life threatening eating disorders are.

Why are transgender people at a higher risk of eating disorders?

Whilst there is no single cause explaining why some people develop eating disorders, body dissatisfaction is one of the strongest predictors for their development (Griffiths and Yager, 2019). Transgender people commonly experience body dysphoria, and body presentation is both internally and externally brought to greater attention for transgender people which may result in increased levels of body dissatisfaction.

Dieting is another significant predictor for the development of an eating disorder. Available research demonstrates that some transgender individuals may start excessively dieting or exercising in an attempt to control difficult and intense feelings about their body, particularly when they feel that it has characteristics that are incongruent with their gender (Griffiths and Yager, 2019). Transgender women describe engaging in behaviours such as restricting their food intake, purging or over-exercising to attain an “ideal” “feminine” appearance, and transgender men have described using similar behaviours to suppress secondary sexual characteristics and menstruation (Harvey, 2019).

Some specific life events have been shown to be risk factors of the development of an eating disorder, for example experiencing sexual, physical, emotional abuse or neglect. Transgender individuals who do not meet normative expectations of gender appearance may be subject to discrimination and violence (Griffiths and Yager, 2019) which could further increase their risk for developing an eating disorder. 

“Trans people do shoulder a burden of eating disorders and more research is required in this area, it may be that the distress associated with being misgendered or otherwise not affirmed, and the pressures of living in a society challenged by cisgenderism may be a driver for disordered eating in trans communities.” ACON, TransHub: Body Image

Healthcare Concerns

When it comes to eating disorders, early intervention is key. However, eating disorders are chronically under-recognised, and this means many people go untreated or don’t present for treatment until some time after they begin experiencing symptoms. 

Accessing healthcare can be a complicated process for transgender people. For some, having a new name, gender expression, or pronouns that don’t appear to ‘match’ their legal documents can be a barrier to accessing healthcare. In addition, many transgender people have experienced discrimination, stigma or ignorance from healthcare professionals (Harvey 2019). In one 2020 study, transgender participants who were currently being treated for eating disorders “frequently reported deficits in their clinician’s gender competence”, leading them to believe that eating disorder treatment was ineffective, or even harmful (Parker and Harriger, 2020). 

“Every queer friendship group has a host of horror stories of healthcare providers who, through ignorance or ill-will, have failed to treat them with dignity and respect, let alone help with whatever brought them to this clinician in the first place. When thinking about something that makes you as vulnerable as seeking eating disorder treatment, it is easy to see how a negative interaction could lead someone to fail to return.” Anthony, Non-binary, Sydney

It is crucial that clinicians are educated on how to respectfully interact with the LGBTQ+ population, as not doing so can further alienate LGBTQ+ individuals and be detrimental to treatment.

ACON have developed a suite of eLearning that can assist in training clinicians in working with LGBTQI+ communities. You can browse their courses here.

Getting Treatment

If you think you or someone you know is struggling with eating, body shape, or weight concerns, seeking help at the earliest possible point is important. You can start by seeking support from a friend or family member, a GP or another trained health professional. 

Skilled health professionals can give you tailored tools and strategies to prevent an eating disorder becoming entrenched and taking over your life. InsideOut has a database which lists a range of professionals and organisations that provide support and care for people living with eating disorders.  

The Butterfly Foundation’s National Helpline counsellors receive regular LGBTQ+ training and are committed to providing free, confidential and non-judgemental counselling, referrals and information. Contact their hotline at 1800 33 4673, or head to their website for links to an online chat.

Other organisations that provide support to members of the LGBTQI+ community include:

1. ACON - A NSW based health promotion organisation that provides a range of services including counselling;
2. Twenty10 - A Sydney based organisation that supports LGBTQI+ youth with a range of services including counselling; and
3. QLife - A nationwide service that provides anonymous and free LGBTQ+ peer support.

To find out more about Eating Disorders head to the InsideOut website.