This article is a summary of a collaborative presentation led by The Dorm and Emil K. Smith, a former member and spokesperson for FEDUP, a collective of trans+ people who believe eating disorders in marginalized communities is a social justice issue.
Transgender and gender-diverse youth are uniquely at risk for eating disorders, and report experiencing eating disorders at about four times the rate of their cisgender classmates. Therapists attribute this to many factors, including (but not limited to) discrimination-based stress and the desire to suppress the body’s changes as they experience gender dysphoria – for example, eating less to stop having their period.
To learn more about how affirming mental health care can support trans youth, we turned to PhD candidate Emil K. Smith, whose studies focus on systemic equitable mental health care for gender diverse patients. Their experience as a behavioral health consultant led them to an enhanced understanding of trans-affirming medical and mental health practices, and Emil is also a former member of and spokesperson for FEDUP, a collective of trans+, intersex, and gender diverse people who believe eating disorders in marginalized communities are social justice issues.
Drawing from FEDUP’s educational library and their own studies, the following article is a summary of Emil’s educational presentation, which describes barriers to equitable care that trans clients face, and how to improve mental health care for this population.
What are the barriers to care for transgender young adults?
As a precursor to understanding how care providers can support trans clients, Emil describes several barriers to care that TGD young adults most commonly face:
- Many doctors have a BMI limit to perform gender-affirming surgery, which can lead a TGD individual to develop disordered eating behaviors to lose the weight needed to access surgery.
- Eating disorders can be under-diagnosed if someone doesn’t look or feel “sick enough.” For example, an individual may experience many disordered eating behaviors but still have a healthy weight.
- Eating disorders may go undiagnosed if they’re only attributed to gender dysphoria. “Medical transition is not necessarily a cure for eating disorders,” says Smith. However, access to gender-affirming medical intervention is extremely important to support TGD youth’s recovery from disordered eating. Both eating disorder treatment and access to gender affirming medical interventions are essential components of many TGD youth’s recovery journeys. Unfortunately, many TGD youth are only able to access one or the other.
Prevention & early detection of eating disorders for TGD clients.
In addition to improving trans-inclusivity in eating disorder treatment, Smith emphasized two keys to reducing the prevalence and severity of eating disorders among TGD youth: prevention and early detection.
Prevention of eating disorders involves open discussions around food that can help someone feel more comfortable talking about their own experiences, which helps care workers detect unhealthy behaviors before they can escalate further.
When therapists or loved ones do approach food conversations with TGD young adults, it’s important to talk about:
- transition-related goals, such as emphasizing the importance of nutrition when it comes to the efficacy of gender-affirming hormones.
- healthy coping mechanisms that they can fall back on in times of stress, instead of disordered eating.
Additionally, care providers can help TGD clients build a support system, such as connecting individuals to a community and peer support group, explore harm reduction techniques with their client, and perhaps most importantly actively listen to the person. Keeping the person at the center and respecting their autonomy is essential to validation, and recovery.
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Finally, Emil notes that everyone’s recovery process is different. The goal of treatment should be to meet the client where they’re at and continue to hold with them that change is possible.
Supportive Language
In terms of treatment, adjusting your language can also be used to better support TGD individuals. The following language conventions are an important place for therapists and caregivers to start:
Important Definitions
- Gender dysphoria: distress from the incongruence between how a person’s gender is perceived and their internal experience of their gender.
- Body dysmorphia: distress due to one’s distorted perceptions of flaws/defects of the body.
- Body dissatisfaction: feeling worthless due to perception of body, hating body, etc.
- Gender euphoria: distinct enjoyment or satisfaction caused by the correspondence between the person’s gender identity and gendered features that are affirming to their identity.
Gender is a Spectrum
Gender is currently understood as a spectrum, where many identities fall outside of the male-female binary, such as genderqueer, genderfluid, and intersex, and language around gender is always evolving, and will continue to evolve. It is important to try to always use language that is most comfortable for the individual. Mirror their language, ask them what they prefer, and be willing to adapt when necessary.
“Body Neutrality” > “Body Positivity”
Smith emphasizes that instead of “body positivity,” terms like “body neutrality” and “body liberation” may be more appropriate for transitioning clients. For example, instead of “you don’t need to change your body,” it could be more beneficial to use the phrases “bodily autonomy,” and “body change acceptance.”
Mirroring Language
Mirroring a client’s language involves using the language that someone uses to self-identify. If they identify as a “trans person,” it is appropriate for people to also use the term “trans person” when talking about them. And, of course, use their pronouns.
Person-centered Language
Instead of saying “She is a transgender” or “She is transgendered,” it is more respectful to say “She is a transgender/trans person.”
Specific Language Around Transitions
Transitioning may look different for each individual and there are several types of transitions, including social transition, medical transition, or legal transition. No matter how a person transitions or where they are in their process, there is no such thing as “not trans enough.”
Supportive Resource for Trans Clients Facing Eating Disorders
Many of the resources available for eating disorder treatment were not made specifically for trans people. For example, the EDE-Q and EDE-QS are validated tools for measuring eating disorder symptoms, but may not encompass the issues unique to TGD individuals, such as gender dysphoria. These resources can be very helpful in the recovery process, but it is vital to take into account that they may not have fully considered trans people during their creation.
Emil outlines several resources and organizations they’ve found supportive of trans clients:
- Association for Size Diversity and Health (ASDAH): a nonprofit organization dedicated to celebrating bodies of all shapes and sizes, helping oppressed communities have equal access to health and well-being.
- Nalgona Positivity Pride (NPP): an organization focused on meeting the needs of BIPOC individuals affected by eating disorders, supporting communities through art, education, and activism.
- Project HEAL: an organization featuring programs that address and break systemic, healthcare, and financial barriers to eating disorder care, providing support to those who do not have access to treatment.
- Fighting Eating Disorders in Underrepresented Populations (FEDUP) Collective: a collective of trans+, intersex, and gender-diverse people working to bring attention to the disproportionate amount of EDs among the TGD population.
How The Dorm Approaches and Provides Affirming Eating Disorder Treatment and Care
Our Holistic Model of Care
At The Dorm we provide young adults with an affirming and inclusive community model that supports clients struggling with disordered eating with a multi-pronged approach, which includes comprehensive assessment and an individualized treatment plan including individual therapy, clinical coaching, and group therapy.
Our therapists and clinical coaches are well-versed in working with clients struggling with food and identity, and are kept aware of evolving language and therapies available for trans young adults through our ongoing DEI trainings and initiatives. Today, about 5% clients in our care are transgender and over 40% are LGBTQ+.
In addition to clinical work, our dedicated Health & Wellness team is well versed in treating eating disorders and collaborates with each client’s clinical team to focus on food, movement, and body image.
Our Nutrition Philosophy
Our nutrition policy utilizes three main models: Health at Every Size, Intuitive Eating, and Freedom From Diet Culture, which align with affirming care principles for young adults transitioning or exploring their identity. Our team is also attuned to gender and eating disorders, and recommends the following paradigms for our diverse community when it comes to helping clients find peace with food:
- The Health at Every Size model is an evidence-based framework of care that celebrates body diversity, challenges cultural norms, and rejects stigmas around weight, which can allow our clients to feel further at peace with their bodies. Research consistently demonstrates that weight and BMI are an inaccurate measure of health; HAES believes that instead of BMI other indicators of well-being, such as behaviors and mindset, are better ways to measure health.
- Intuitive Eating allows for an individualized look into a client’s relationship with food and their body. Through this model, clients will learn to identify obstacles of body respect, address and improve negative thought patterns, and respond to hunger and fullness cues.
- Freedom From Diet Culture encourages clients to step away from the rigid expectations associated with dieting and diet culture, such as values of thinness over health. Diet culture is shown to be harmful to a person’s relationship with their body and food, increasing body dysmorphia, disordered eating, eating disorders, and other mental health issues. Therefore, we at The Dorm work to ensure that we are a diet-culture-free environment to help clients feel safe in our community.
With our registered dietitians and clinicians, we strive to help clients find freedom from issues of body image, food rules, disordered eating, and eating disorders. We intend to reduce clients’s stress about food and their bodies through respectful, individualized, and stigma-free care.
In conclusion, we were so pleased to have Emil Smith take the time to speak with and educate us further about eating disorders in transgender and gender diverse populations. To learn more about their studies or to be put in touch with Emil, get in touch at [email protected].
