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Eating disorders and gender diversity

Research shows that gender diverse young people experience higher rates of eating disorders when compared with cisgender (i.e., not gender diverse) people. They also experience higher rates of disordered eating. For example, in Trans Pathways we found:

• 22% of gender diverse young people had ever been diagnosed with an eating disorder.
• 2 in 3 had ever limited their eating because of their gender identity and/or expression.
• 1 in 3 had ever increased their eating because of their gender identity and/or expression.

Here’s some information and resources you may find helpful if you are concerned about your child. Click here for a short video addressing common misconceptions about eating disorders.

Mental Health & Wellbeing
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Why do gender diverse people have higher rates of eating disorders and disordered eating?

There isn’t a simple answer but, according to research, the strongest factor related to developing an eating disorder appears to be body dissatisfaction. As gender diverse people commonly experience body dysphoria (feeling unhappy, dissatisfied, or frustrated with their body), and they may be particularly aware or self-conscious about their bodies, these factors may contribute to greater levels of body dissatisfaction. Evidence also suggests that gender diverse young people may change their eating behaviours to align their bodies with their gender identity.

Dieting is another strong factor related to developing an eating disorder. Research shows that some gender diverse people may start excessively dieting or exercising to control strong negative feelings about their body, especially when they feel it doesn’t fit with their gender identity. For example, gender diverse people with a feminine gender identity may restrict the amount of food they eat, or exercise excessively to achieve the ‘ideal’ feminine body shape. Gender diverse people with a masculine gender identity might do so to stop their bodies developing female characteristics and having periods.

Additionally, negative life events such as experiencing emotional or physical abuse are also risk factors for developing an eating disorder; research shows gender diverse people experience higher rates of these negative experiences putting them at greater risk for eating disorders. Importantly, research shows being connected with, and supported by, family is associated with lower rates of eating problems, especially for 14 to 18 year olds.

What are the signs of disordered eating?

Below are some of the common signs of disordered eating although this can look different for each person. It’s important to remember that someone might have a combination of these signs, just one of them, or none. Also, it is worth noting that having one or more signs does not necessarily indicate disordered eating. Sometimes people can also be secretive about their eating behaviour or not recognise that the behaviour is a problem.

Physical signs

• Rapid weight loss/frequent changes in weight
• Periods stopping or being disrupted
• Fainting/dizziness
• Feeling tired, poor sleep, feeling low in energy, feeling cold a lot of the time
• Damage from vomiting such as damage to teeth, bad breath, swelling in the lower half of the face, callouses on knuckles.

Psychological signs

• Being pre-occupied with eating, food, body shape and weight
• Feeling anxious/irritable around meal times
• Feeling ‘out of control’ around food
• ‘Black and white’ thinking such as fixed thoughts about food being ‘good’ or ‘bad’
• Having a distorted sense of body image
• Comfort eating to deal with feelings such as stress or depression
• Using food as self-punishment (e.g., refusing to eat for emotional reasons)

Behavioural signs

• Dieting behaviour such as counting energy intake, fasting, avoid certain food groups (e.g. carbs)
• Eating by themselves and avoiding eating with other people
• Signs of binge eating (e.g., food disappearing, hoarding food)
• Frequent trips to the bathroom during/shortly after eating
• Vomiting or using laxatives, enemas, appetite suppressants or diuretics
• Compulsive or excessive exercising
• Changes in food preferences (e.g., refusing food previously enjoyed, becoming pre-occupied with ‘healthy eating’, having fluids instead of meals)
• Obsessive rituals around eating and preparing food (e.g., eating very slowly, cutting food into very small pieces)
• Being very sensitive to comments about body shape/weight and/or eating/exercise habits
• Secretive behaviour regarding food (e.g., saying they have already eaten when they haven’t, hiding food)

Getting help

If you are worried about your child’s eating behaviours the following information and resources may be helpful:
• Seeking help as early as possible is important. You can start with your GP or InsideOut, the Australian Institute for Eating Disorders, maintains a Treatment Services database of skilled health professionals and a database of support organisations in your area.
Research indicates that gender diverse people can have negative experiences with eating disorder treatment when clinicians are not experienced as competent in treating gender diverse patients. Head to our Medical Considerations page for resources that can help you to pick the right health professional.
• The Butterfly Foundation has a fantastic hub of resources, tips and advice specifically for LGBTQIA+ individuals experiencing eating disorders and body image concerns.
• The Butterfly Foundation’s counsellors also receive regular LGBTQ+ training and they are committed to providing free, confidential and non-judgemental counselling, referrals and information. Contact their hotline at 1800 33 4673 or via webchat everyday 8am – midnight (AEST/AEDT). Their site also contains resources for coping with eating disorders, details of support groups, and information for carers.