Gender-Affirming Care for Eating Disorders

When 21-year-old author and reality television star Jazz Jennings opened up to the public about her recent diagnosis of binge eating disorder, some fans assumed that her struggles with her weight and eating habits stemmed from her identity and experiences as a transgender woman. But Jennings emphasizes that her eating disorder is unrelated to being trans. "It's really important that people realize that yes, I do have mental health issues. No, it has nothing to do with me being transgender or my transition," she said in a recent interview with TODAY. That distinction is an important one for clinicians to remember as well. While research has documented that transgender people are often at higher risk of developing eating disorders, being trans is not a mental health condition and does not always trigger mental health challenges. But conventional eating disorder screening and treatment may not be sensitive to the needs and experiences of trans people, which means that they may have a harder time accessing appropriate care that affirms their gender identity – without pathologizing it. 

Five Ways for Providers to Practice Gender-Affirming Care

Here are a few ways that eating disorder treatment providers can better provide gender-affirming care to patients who are not cisgender, drawn from a recent special article in the journal Pediatric Annals. 

1. Use appropriate screening measures and nutrition models. Clinical tools developed for cisgender people may miss signs of unhealthy changes in weight in transgender people, as these tools often use standard growth curves based on assigned sex. Clinicians can take care to look for behavioral signs of eating disorders and seek out gender nonspecific diagnostic instruments and nutrition protocols. 
2. Provide referrals to tailored health services. Many transgender people experience gender dysphoria, which is acute distress related to the difference between their affirmed gender and the gender they were assigned at birth. Gender dysphoria can be related to disordered eating, but gender-affirming medical treatments (such as hormone therapy) can reduce gender dysphoria. Accordingly, eating disorder clinicians should refer patients to specialized health services for transgender people when appropriate. This referral can be particularly important for younger patients who are still undergoing puberty. 
3. Foster strong family relationships. Family support is a key predictor of positive outcomes for transgender youth. Eating disorder treatment should incorporate facilitating accepting relationships between the patient and their family, including referrals to outside support if necessary. 
4. Develop gender-inclusive facilities and processes. Ensure that all patients are able to use restrooms and (if applicable) residential spaces that match their affirmed gender or that are gender nonspecific. Intake forms and other paperwork should include space for patients to specify their accurate names and personal pronouns, which may not match their legal names. 
5. Train staff in inclusive practices. Be sure that staff know your clinic's policies around using accurate names and pronouns, and have staff specify their pronouns as well. You can also have staff attend regular trainings for working with transgender clients and develop an inclusivity and non-discrimination policy if you don't already have one.

 To learn more about the language used to discuss gender identity, you can refer to the Human Rights Campaign’s helpful glossary. If you or a loved one is struggling with an eating disorder, please reach out to our team at info@columbuspark.com to discuss treatment options, including our comprehensive DBT-ED.