“I’m Still Not Sure If the Eating Disorder is a Result of Gender Dysphoria”: Trans and Nonbinary Individuals’ Descriptions of Their Eating and Body Concern

Why is this research important?

Transgender and gender diverse people report high levels of body dissatisfaction and are at an elevated risk of experiencing disordered eating and eating disorders. However, when compared with their cisgender counterparts (primarily cisgender women) there is a scarcity of research on understanding the experience of disordered eating and eating disorders for trans and non-binary people. This study details trans and non-binary individuals’ experiences of eating disorders, disordered eating and/or body image concerns in relation to their gender identity and gender expression. This study highlights important issues regarding the relationship between gender dysphoria and eating disorder psychopathology, such as, the potential for the eating disorder to serve a functional role in relation to gender dysphoria (e.g., to manage uncomfortable emotions related to their gender identity and/or, to punish their bodies and themselves). This research also found that distress and associated behaviours related to both gender dysphoria and disordered eating and/or eating disorder can be reciprocal and reinforcing. This has important implications for the treatment of trans and non-binary people experiencing disordered eating and eating disorders. For example, the study underscores the need for the experiences of each individual to be understood and considered when designing integrated treatment approaches where both gender dysphoria and disordered eating or eating disorders can be addressed in tandem. This research also highlights the importance of clinicians working in the field of eating disorders to be competent in working with gender-diverse people.

Authors: Claire E. Cusack, Alan O. Iampieri, and M. Paz Galupo


Conceptualisations of eating disorders (ED) have primarily been based on the experiences of cisgender women. Yet trans and nonbinary individuals (TNB) may be at greater risk than cisgender individuals to suffer from eating disorders, disordered eating, and body image concerns. The current study takes a phenomenological approach to explore how TNB individuals conceptualise eating and/or body image issues. Qualitative data were obtained from 82 TNB participants who self-reported eating and/or body image concerns. Primary analyses focused on participants’ responses to an open-ended prompt regarding how participants understand the relationships among gender identity, gender expression, and weight and shape control behaviors. Thematic analysis identified five themes: (a) gender dysphoria, (b) puberty, (c) emotion (dys)regulation, (d) gender expression, and (e) recovery/transition. Results indicate various factors salient to gender identity and expression and eating concerns. Findings extend beyond the traditional focus on gender dysphoria by highlighting other important factors for TNB individuals, such as the function ED psychopathology serves (e.g., gender avoidance and self-punishment). This broadens the ED field’s understanding of how gender dysphoria relates to ED psychopathology, rather than focusing solely on the physical body. Distress and associated behaviors related to both gender dysphoria and eating disorder psychopathology may be reciprocal and reinforcing and, as such, should be considered in tandem in treating TNB clients experiencing EDs and body image concerns. This work may better identify ED risk and maintenance within this population and thus optimise prevention and intervention.

Access: Closed

Link: https://psycnet.apa.org/record/2022-25381-001

Citation: Cusack, C. E., Iampieri, A. O., & Galupo, M. P. (2022). “I’m still not sure if the eating disorder is a result of gender dysphoria”: Trans and nonbinary individuals’ descriptions of their eating and body concerns in relation to their gender. Psychology of Sexual Orientation and Gender Diversity.

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