Eating disorder recovery is different for transgender and non-binary individuals, but care centers don’t always recognize that. How can trans and NB individuals get the care they need, outside of a cis-het framework?

Convention associates eating disorders with cisgender women: women who identify with the female body they’re born into, and whose eating disorder is driven by conventional feminine ideals. However, different internal struggles can also motivate disordered eating, and these struggles must be addressed for effective recovery.

Transgender and non-binary individuals who live with these syndromes can therefore feel out of place in eating disorder recovery and treatment; the underlying cognitive processes may be very different for transgender folks than the cis-gender patients providers expect to encounter. 

If you are trans or nonbinary in eating disorder recovery, you might feel doomed to misunderstanding and isolation in the healing process. But have hope; we can take inspiration from lived experience, and create systems of support for ourselves both inside and outside of the binary system. This article is your roadmap.

First, what is gender identity? 

Doctors usually identify us as either male or female based on biological sex at birth. However, our internal concept of our own gender can develop throughout life, irrespective of gender assigned at birth. Someone born as a female and therefore raised as a girl can later truly identify as a man, and vice versa. 

Perhaps the labels “male” and “female” fail to capture your experience at all. Society’s male/female binary has limited gender identity to two options. However, the spectrum of gender flows between and extends beyond male and female labels. For instance, discussions of gender often exclude agender, non-binary, and gender-fluid folx — because these concepts don’t gel with heteronormative assumptions. 

You can feel like no label fits; or you can create your own label that helps others describe their experience, too. We only have terms for these identities because some brave souls decided:​ ​”I can’t be alone in feeling this way. My experience is valid.” 

How does gender expression relate to eating disorders?

A 2015 survey of 300,000 college students found that transgender students were almost four times more likely to have an eating disorder than​ ​cisgender students​. Right there, we have evidence of a connection between eating disorders and transgender identity. How do we make sense of this connection? 

Monte Nido, an eating disorder treatment center, offers resources detailing risk factors for transgender individuals on their website. In answer to our question, they detail that discrimination, lack of support, and existing body image issues at high rates predispose transgender and non-binary people to eating disorders. 

Gender discrimination’s impact on trans mental health

The stress and alienation of stigma wear on transgender and non-binary individuals’ emotional wellbeing. According to the authors of a study on gender identity and eating disorders, from​ ​Washington University St Louis School of Medicine​: 

“Among lesbian, gay, and bisexual individuals, a strong link has been found between higher levels of minority stress and poorer mental health outcomes. The same mechanisms are likely at play in transgender individuals, who may be exposed to substantial amounts of discrimination, both on an interpersonal and societal level.” 

Discrimination signals the brain that you’re not accepted, safe, or welcome in your surroundings. When you get those messages from your environment, you’re more likely to critique yourself–sometimes to the point of developing disordered eating. 

Lack of support inflames negative self image

Speaking of self-criticism, we’re more likely to feel inadequate or abnormal when we feel isolated from the support we need. Whether you feel misunderstood by family, excluded by coworkers, or pressured by society to conform, this lack of acceptance tricks your brain into thinking that ​you’re broken​–when the real problem is that those around you don’t know how to process your non-conforming identity. 

Body image frustration and disordered eating

Body image-based mental health struggles can especially contribute to disordered behaviors like restricting food intake. Via phone interview, therapist Kara Seaburg, who specializes in eating disorder recovery, explains the emotional underpinnings of this connection. 

Disordered eating can feel like a tool to make one’s body type more like that of that of the desired gender expression. For instance, especially “…if it’s female to male and people’s parents aren’t supportive, eating disorders naturally occur. If you don’t want your body to develop and be more female, the way to do that is not to develop. Which is to not eat.” 

Eating disorder treatment for transgender and non-binary people

How can you get effective treatment when your community doesn’t understand the identity-specific support you need? For many folks with eating disorders, residential treatment provides an ideal environment for healing. Does that hold true for transgender and non-binary folks in recovery? If not, what are our options? 

What is residential treatment and how can it help?

Therapist Amanda Hough, LCSW describes residential treatment as living in a community that focuses on helping people with a specific issue. For example, eating disorder residential centers provide groups on nutrition education, body-image, and structured food support. 

One plus side to residential treatment is how immersive it is. “You get to know the people who you’re working with. You’re there 24/7 so we can see you all the time…I think it sets the ground and the foundation for successful therapies moving forward.” 

Who might choose residential treatment over therapy? 

According to Hough, “If there’s a critical problem, going outpatient for an hour a week may not do anything for you.” Residential treatment provides a round-the-clock supportive environment, for those whose eating disorder will flare between regular therapy sessions. 

Will they understand me if I’m not the cis-het female they’re used to helping? 

Unfortunately, most eating disorder specific centers separate patients by male or female gender assigned at birth. This prevents transgender and non-binary folx from receiving the validation and help that they need. 

Gender-affirming​ centers accept patients of all genders and provide appropriate medical care and housing. You can look for this specification when researching programs. 

What if I’m in a residential center that doesn’t honor my gender identity? 

While residential treatment centers oftentimes separate patients based on gender assigned at birth, transgender patients can request housing with whichever sex they feel most comfortable with. 

Of course, this advocacy only solves a fragment of the problem for certain gender queer individuals. However, non-conforming individuals’ housing advocacy at least begins a conversation about gender that may lead to more inclusive treatment. 

If you’ve had negative experiences seeking treatment, try to keep an open mind; as corny as that sounds, it seems that centers are slowly becoming more accommodating. Seaburg noted a progressive change at the center where she works. Now, individuals “can be put in the pod of their choice, which I think is very appropriate.” 

Remember that you’re entitled to ask that your identity be respected; although explaining your situation may feel uncomfortable, it can’t hurt the situation. 

Reducing loneliness and alienation for transgender and non-binary people with eating disorders

Transgender and non-binary folx with eating disorders deserve better professional support from treatment centers; in lieu of (or ideally, ​in addition to​) that, individuals can also build their own outpatient support systems. This involves identifying effective supports for your recovery, that also allow you to fully inhabit your gender identity. 

Eating disorder recovery supports for trans folks

A whole host of outpatient supports exist for transgender and non-binary people feeling isolated. Helpful resources to keep on hand: 

1. Eating Disorders Anonymous now offers online zoom meetings throughout the week. One of the inclusive groups on their platform is Transgender/Intersex/Nonbinary (T.I.N.) Meeting, which meets once a week on Sunday​s. 

2. Trans Folx Fighting Eating Disorders (TFFED) is a collective​ ​that runs​ support groups for gender-diverse and BIPOC folx with eating disorders. 

3. Beat Eating Disorders UK features stories of people with eating disorders, including pieces written by​ ​trans folx​. 

4. Supportiv has anonymous, small-group peer support chats available 24/7 with no signup. Users are matched with folks going through the most similar struggles, and custom resource recommendations are available. 

Institutional Work is Vital

In my interview with Amanda Hough, I asked for professional thoughts on what trans folx can do if they cannot access the informed residential treatment that they need.

“I don’t know,” Hough responded, “and I think that’s the problem. There should be more options…so that people don’t always have to feel like the outsider.” Eating disorder treatment needs revamping in order to effectively serve transgender and non-binary folks. 

Until the professional systems already in place can provide inclusive care, we can work through loneliness and build support networks for ourselves. We can prop each other up, and help each other when self-advocacy causes anxiety. And when nobody gets it and you feel as alone as ever? Know that you can always find someone who’s familiar with this struggle–or who ​wants​ to understand–in Supportiv’s anonymous peer support chats.

This article is part of Supportiv’s Amplify article collection.