Eating disorder rates vary among different groups of transgender and gender diverse people

Eating disorders are frequently conceptualised and talked about along gender lines: women are more likely to be diagnosed with anorexia or bulimia, while men are more likely to face stigma and go undiagnosed. However, these discussions largely focus on cisgender people – those who identify with the gender they were assigned at birth. Yet many trans and gender diverse people also experience eating disorders, and there is also variance within these groups that largely goes unnoticed.

A new study published in Annals of Epidemiology looks at eating disorder risk and diagnosis across transgender and gender diverse students in the US. The team finds significant variability within this broad group of people, with those with certain gender identities and sexualities more at risk of eating disorders than others.

Data was collected from the 'Healthy Minds Study', an annual survey about mental health taken by graduate and undergraduate students in the US. Participants self-identify their gender in the survey, selecting both their assigned sex at birth and their gender identity (male, female, trans man or trans woman, genderqueer or gender non-confirming, or other).

From this, the team generated four categories: transgender men, transgender women, genderqueer or gender non-conforming, and gender expansive (those who do not follow gender stereotypes). Participants then described their sexual orientation, resulting in five categories: heterosexual, gay or lesbian, bisexual, queer, and other. Finally, participants reported eating disorder symptoms and indicated whether or not they had ever been diagnosed with anorexia or bulimia by a healthcare professional.

Genderqueer/gender non-conforming students were most likely to be at risk of eating disorder (38.8% of this group showed "clinically relevant" eating disorder symptoms), followed by trans women (37.1%), gender expansive students (34%), and trans men (34%). Diagnosed eating disorders were most prevalent in gender expansive students, genderqueer students and trans men, much more than rates in trans women.

There was also variation between people of different sexualities. Trans men who identified as gay, bisexual or queer were more likely to be at risk of an eating disorder than straight trans men; similarly, LGBQ gender non-conforming people were nearly five times as likely to be at risk of eating disorder compared to gender non-conforming students who described themselves as heterosexual. Bisexual and queer trans women were more at risk than straight or lesbian trans women: bisexual trans women, for example, had 149% times higher odds of eating disorder risk compared to heterosexual trans women.

The team suggests that non-cisgender students face specific challenges and pressures, including discrimination from teachers and other students, that put them at risk of developing an eating disorder. Gender dysphoria may be a significant factor here as students struggle to feel comfortable in their bodies. Future research could further investigate the specific factors that put gender non-conforming young people at risk of eating disorders.

The paper also makes it clear that 'trans people' or 'gender non-conforming' people are not a homogenous category, but an incredibly diverse group of people who face many overlapping challenges based on gender identity and sexuality (and potentially race, class, disability and other factors). Someone who is gender non-conforming and bisexual, for example, might face risks because of both discrimination due to their gender and biphobia within the queer community, with stressors coming from both within and outside their immediate peer group.

So, not only does this mean that non-cisgender students may need targeted support compared to their cisgender peers, but also that it's important to consider how eating disorders might manifest differently within these groups. Developing ways to ensure that trans and gender non-conforming students are protected from discrimination from cisgender peers is important, but so is fostering trans and queer spaces that are safe for everyone in the community.