Exploring Eating Disorders Among Transgender Adults

Introduction

In the quiet of a therapy room, or perhaps across the soft hum of a video call, stories unfold of struggle, courage, and resilience. For transgender adults, the experience of living within a society that does not always recognize or affirm their identities brings unique complexities—and for some, these challenges manifest as eating disorders. These are not simply issues of food or body, but of identity, acceptance, and the deep desire to find peace within oneself. Yet, while mainstream discussions on eating disorders are widespread, the narratives and needs of transgender adults remain largely overlooked.

Eating disorders in transgender communities are often shaped by intersecting forces: the pressures to fit binary gender norms, the internal conflict of gender dysphoria, and, for some, the trauma of navigating systemic discrimination. As clinicians, allies, or those seeking understanding, acknowledging these influences is crucial to fostering inclusive, affirming support. By viewing eating disorders among transgender adults through a compassionate, gender-affirming lens, we can recognize the layered challenges they face and address them in ways that honour their identity and experiences.

This blog offers an exploration into these layered experiences, with guidance for therapists, allies, and transgender individuals themselves. Together, we can deepen our understanding, dismantle harmful stereotypes, and pave a path toward healing that is as expansive and diverse as the identities of those it seeks to support.

Gender Dysphoria and Body Image Distress

For transgender adults, gender dysphoria—the deep discomfort arising when one’s physical appearance or bodily attributes feel incongruent with their gender identity—often brings a complex relationship with body image. This dissonance can amplify distress around appearance, leading some individuals to seek control over their body through disordered eating behaviours. In these cases, the act of restricting, purging, or binge eating may serve as an attempt to reshape the body in ways that feel aligned with their internal sense of self, though often at a cost to physical and mental health.

Dysphoria’s Role in Disordered Eating Behaviours

Imagine a trans-masculine individual who feels a persistent disconnect with parts of their body that read as “feminine.” For some, the urge to restrict food intake can become a means of managing the discomfort of certain physical traits, like breast tissue or soft facial features. Restriction may offer a temporary sense of control over the body, as well as a way to suppress aspects of appearance that feel incongruent with their gender identity. However, while these behaviours may initially provide relief, they can lead to harmful cycles of malnutrition and emotional turmoil. Research supports that among transgender populations, gender dysphoria frequently drives disordered eating as a coping mechanism, turning the body into a focal point for managing deeper struggles with identity and self-perception (Chang, Singh, & Dickey, 2018).

As clinicians, it is essential to recognize these complex motivations behind disordered eating in transgender adults. Exploring the relationship between body image, dysphoria, and eating habits within a supportive, non-judgmental space can allow clients to begin disentangling self-worth from physical appearance, fostering a healthier and more compassionate relationship with their bodies.

Body Dissociation and Eating Behaviours

Beyond gender dysphoria, the experience of gender incongruence can create a sense of body dissociation—a feeling of detachment from or even estrangement toward one’s own body. This dissociation can deeply affect one’s relationship with food. For some transgender adults, disordered eating may act as a form of self-regulation to navigate or cope with this detachment. For example, someone who feels dissociated from their body might engage in restrictive eating as a way to feel “numb” or disconnected from a body that does not align with their gender identity. In such cases, food and eating behaviours become a way to manage the psychological distress of body incongruence, even if the effects are temporary and ultimately damaging.

Understanding this dissociative response is crucial in gender-affirming therapy. Helping clients explore how these feelings of disconnection arise—and gently guiding them toward reconnecting with their body in an affirming way—can be a powerful therapeutic goal. Techniques such as mindfulness, grounding exercises, and body-centered therapies may assist clients in re-establishing a positive relationship with their physical self, creating a path toward both mental and bodily alignment.

Social and Cultural Pressures

For transgender adults, navigating a world shaped by rigid gender norms can heighten pressures to conform to binary ideals of masculinity and femininity. This societal expectation places significant weight on appearance, reinforcing narrow ideals of what it means to look “male” or “female.” The struggle to achieve these externally imposed ideals often leads to feelings of inadequacy and frustration, particularly when one’s body doesn’t conform to culturally idealized standards. These pressures are further complicated by the pervasive discrimination and internalized stigma faced by many transgender individuals, collectively known as minority stress. Additionally, in today’s digital age, social media and online communities can play a dual role—offering connection and support, while simultaneously reinforcing harmful body ideals.

Binary Gender Ideals and Body Image

The deeply ingrained binary views of gender in society place an undue emphasis on physical characteristics to define masculinity and femininity. For transgender adults, striving to embody these binary ideals can lead to a fraught relationship with their own body. A trans-feminine individual, for example, might feel pressure to attain a thin, petite frame commonly associated with femininity, leading to restrictive eating habits or excessive exercise. Meanwhile, a trans-masculine individual may attempt to build muscle mass and restrict their diet to achieve a more angular, traditionally “masculine” physique. These efforts, while understandable, can escalate into unhealthy behaviours and contribute to the development of eating disorders, particularly when the body resists these forced transformations (Counihan, 1999; Chang, Singh, & Dickey, 2018).

As therapists, it is crucial to foster discussions with clients about these pervasive gender ideals and help them explore how cultural expectations might be impacting their relationship with food and their bodies. In doing so, we encourage a path toward self-acceptance that respects and validates each person’s unique gender expression, beyond the confines of societal norms.

Minority Stress and Internalized Stigma

Transgender individuals encounter ongoing discrimination and societal rejection, leading to what is often referred to as “minority stress” (Meyer, 2003). This stress encompasses a range of chronic challenges, from overt acts of discrimination to subtle, pervasive invalidations. Over time, these experiences can accumulate, creating an internalized stigma that leads individuals to feel “less than” or unworthy in a society that fails to affirm their identities. Such experiences can intensify body dissatisfaction and, for some, lead to maladaptive coping mechanisms, including disordered eating.

Therapeutic work with transgender clients around minority stress should include recognizing and validating the deep impact of these societal pressures on self-worth and body image. Exploring the roots of internalized stigma with clients and empowering them to resist these imposed beliefs can promote healing and resilience, affirming that their worth and identity are valid, regardless of societal expectations or body ideals (Chang et al., 2018).

The Role of Social Media and Online Communities

Social media and online communities can be both a lifeline and a trap for transgender adults seeking validation and connection. For some, these platforms offer an invaluable space to connect with supportive peers, share experiences, and find solidarity. However, within these digital spaces, certain subcultures may also promote unrealistic body standards or “thinspiration” ideals, amplifying pressures to achieve a specific body type. Posts that glorify extreme thinness or hyper-masculinity, for instance, can fuel body dissatisfaction and trigger harmful eating behaviours in those already grappling with dysphoria and societal rejection (Erickson-Schroth, 2014).

As clinicians, we can help clients critically assess the media they consume, encouraging mindful engagement with social media to prioritize supportive content over sources that reinforce unrealistic standards. Guiding clients to online communities that genuinely celebrate body diversity and affirm transgender identities can create a more positive and affirming digital experience.

Barriers to Seeking Treatment

For transgender adults, seeking treatment for eating disorders can feel like navigating a labyrinth filled with obstacles that extend beyond personal struggles with food and body image. From encountering healthcare providers who lack understanding of gender diversity to facing complex barriers created by intersecting identities, the path to support is rarely straightforward. These challenges are compounded for those with experiences of discrimination and trauma, which can lead to a profound distrust of the very systems meant to offer help. By understanding these barriers, clinicians, allies, and healthcare institutions can take steps to create a more accessible, compassionate, and affirming path to care.

Limited Access to Trans-Affirming Care

One of the most significant barriers to treatment for transgender adults is the limited availability of trans-affirming care. Many healthcare providers lack the training or cultural competence to respectfully engage with transgender clients, which can lead to misgendering, invalidation, and misunderstanding. Misgendering—referring to a person by incorrect pronouns or names—is not only distressing but can also reinforce feelings of erasure and dysphoria, deterring individuals from continuing with treatment. Furthermore, the absence of gender-affirming language or inclusive intake forms can make therapy settings feel unwelcoming, adding another layer of discomfort and resistance to seeking care (Chang, Singh, & Dickey, 2018; Counihan, 1999).

For therapists, adopting a gender-affirming approach means committing to continuous learning, embracing gender diversity, and creating a welcoming environment that respects each client’s identity. This involves not only using correct names and pronouns but also actively validating the unique experiences and identities of transgender clients. Simple changes—like using inclusive language and acknowledging the importance of gender identity in discussions of eating behaviours—can transform the therapeutic environment, making it safer and more supportive.

Intersectionality and Unique Challenges

The intersecting identities of transgender adults—such as race, socioeconomic status, and sexual orientation—add layers of complexity to their experience with eating disorders and access to treatment. Black, Indigenous, and people of colour (BIPOC) who are also transgender may face additional challenges due to racial discrimination and systemic biases within the healthcare system. These intersecting identities can amplify the difficulties of accessing gender-affirming, culturally competent care, as treatment options may be limited or inaccessible to those who lack financial resources or live in under-resourced areas (Crenshaw, 1991; Meyer, 2003).

For example, a low-income, BIPOC trans woman may experience compounded discrimination based on race, gender identity, and socioeconomic status, making it challenging to find a provider who not only affirms her gender but also understands the cultural nuances of her experiences. Recognizing these intersectional challenges is essential in providing meaningful support, as each identity can influence how clients experience both their eating disorder and the healthcare system. An intersectional approach to therapy seeks to address these layers of identity and to empower clients by validating their experiences in a way that reflects their unique realities.

Fear of Discrimination and Trauma

For many transgender adults, the healthcare system itself is a source of trauma. Past experiences of discrimination, rejection, or mistreatment by medical and mental health professionals create a lasting impact, often leaving clients wary of re-entering similar spaces. Research shows that transgender individuals frequently report negative interactions with healthcare providers, which can include dismissiveness, stereotyping, or overt discrimination. These experiences cultivate a profound distrust in healthcare institutions, leading many to avoid treatment for fear of further harm (Chang et al., 2018; Erickson-Schroth, 2014).

Therapists working with transgender adults must understand this history of trauma and recognize the courage it takes for clients to seek help despite these fears. Trauma-informed care, which prioritizes safety, trustworthiness, and empowerment, can be instrumental in rebuilding trust. Validating the client’s past experiences of discrimination and creating a therapeutic relationship grounded in respect and transparency can help clients feel safe and supported, allowing them to engage more fully in the healing process.

Treatment Approaches and Support Strategies

When it comes to supporting transgender adults with eating disorders, embracing inclusive, affirming, and compassionate treatment approaches is essential. A gender-affirming framework recognizes that each client’s gender identity is not just relevant but central to their experience of body image and disordered eating behaviours. In addition to affirming identity, incorporating trauma-informed and resilience-based techniques and fostering community support can greatly enhance treatment outcomes by addressing the specific needs of transgender individuals in a holistic, supportive way.

Gender-Affirming Treatment Models

Gender-affirming care forms the foundation of a supportive treatment model for transgender individuals with eating disorders. Unlike traditional models, which often overlook gender identity, gender-affirming care actively acknowledges and respects each client’s unique gender experience, integrating it into the treatment plan. This means that discussions around body image, weight, and physical appearance are handled with sensitivity to the client’s gender identity and personal goals. For instance, a gender-affirming approach might involve exploring how specific body changes associated with disordered eating behaviours align with or diverge from a client’s identity and values (Chang, Singh, & Dickey, 2018).

Practicing gender-affirming care also means creating a safe environment where clients feel respected and understood. Simple but impactful actions, such as using correct names and pronouns, validating the client’s gender experience, and acknowledging the role of gender dysphoria, can foster a sense of safety. This supportive environment allows transgender clients to engage more openly with treatment, reducing the internalized shame that often accompanies both gender dysphoria and disordered eating. By affirming clients’ identities throughout treatment, therapists can foster greater trust and self-acceptance, encouraging clients to pursue recovery in ways that genuinely reflect their true selves.

Trauma-Informed and Resilience-Based Therapies

For many transgender adults, trauma is woven into the fabric of their experiences, often resulting from past discrimination, social rejection, or invasive medical encounters. Trauma-informed care is crucial in addressing the root causes of disordered eating, as it recognizes how these past traumas can shape current eating behaviours and body image struggles. Trauma-informed approaches prioritize safety, trust, and autonomy, helping clients feel in control of their therapeutic journey rather than feeling subjected to it (Singh et al., 2011).

In addition to addressing trauma, resilience-based therapies empower clients by focusing on their strengths and coping mechanisms. Resilience-based strategies may include identifying personal strengths, developing positive self-talk, and nurturing healthy relationships. For transgender clients, who may have navigated significant adversity, exploring and cultivating resilience can offer a sense of empowerment and hope. Building on the resilience they have already demonstrated in other areas of life, therapists can encourage clients to apply these strengths to their journey of healing from disordered eating. This approach reframes the treatment experience as not only a path to recovery but also a journey of self-empowerment and resilience (Richmond, Burnes, Singh, & Ferrara, 2017).

Community and Peer Support

The power of community cannot be understated, especially for transgender individuals who may feel marginalized in traditional treatment settings. Peer support and community-based resources provide invaluable opportunities for connection, validation, and shared understanding. For transgender adults with eating disorders, finding peers who have similar experiences can alleviate feelings of isolation and affirm that they are not alone in their struggles. Community spaces—whether online groups, support circles, or trans-led wellness workshops—offer a space where clients can openly discuss their experiences with others who understand the unique intersections of gender dysphoria and eating disorders (Erickson-Schroth, 2014).

For therapists, connecting clients with peer support resources can be a valuable extension of treatment. Encouraging clients to participate in gender-affirming, community-based programs can foster belonging and self-acceptance, as well as provide positive role models. Additionally, peer support networks can offer practical coping strategies and tools for managing dysphoria, body image distress, and social challenges related to identity. This sense of shared experience and understanding can be instrumental in helping clients feel grounded, validated, and resilient in their recovery journey.

Building a Path Forward

Creating meaningful and lasting change in how we approach eating disorders among transgender adults requires more than individual support; it demands a collective commitment to advancing research, transforming policy, and centring transgender voices in treatment development. By building a path forward that prioritizes inclusivity, advocacy, and collaboration, we can work towards a healthcare landscape that genuinely serves the needs of transgender individuals. This approach not only fosters a deeper understanding of transgender experiences but also empowers individuals and communities alike to reclaim their right to accessible, respectful, and effective care.

Encouraging Inclusive Research

One of the most pressing needs in the field of eating disorder treatment for transgender adults is the expansion of research that centres their unique experiences. Historically, eating disorder research has largely excluded transgender populations, leading to a scarcity of evidence-based, gender-affirming interventions. To better understand the intersections of gender dysphoria, body image, and eating behaviours, it is crucial to conduct inclusive research that explores the distinct experiences and challenges of transgender adults (Dalzell & Protos, 2020). Such research can provide vital insights into how gender identity influences disordered eating and can inform the development of treatments that reflect these realities.

Encouraging greater representation of transgender individuals in research is a foundational step toward creating effective, gender-affirming interventions. By collaborating with transgender researchers, practitioners, and community leaders, the mental health field can ensure that research is not only inclusive but also deeply reflective of the complexities and diversity within transgender communities.

Advocacy for Policy Change

While inclusive research lays the groundwork for understanding, policy change is essential for translating these insights into real-world impact. Transgender individuals continue to face barriers in accessing affirming healthcare due to systemic inequities, including limited insurance coverage for gender-affirming treatments and a lack of provider training in transgender health. Advocating for healthcare policies that prioritize inclusivity and accessibility is key to ensuring that transgender adults can access the mental health and eating disorder care they deserve (Erickson-Schroth, 2014; Chang, Singh, & Dickey, 2018).

Policy advocacy efforts might include lobbying for expanded insurance coverage for gender-affirming treatments, funding for transgender-specific mental health programs, and mandating comprehensive cultural competence training for healthcare providers. By working collectively to advance these changes, we can help remove the structural barriers that prevent transgender individuals from receiving compassionate and appropriate care.

Empowering Transgender Voices in Care

A truly inclusive approach to eating disorder treatment cannot be realized without directly involving transgender individuals in the design and implementation of care programs. Empowering transgender clients to share their perspectives and provide feedback on treatment experiences fosters a collaborative approach that respects their lived expertise. Treatment centers and clinicians should actively seek to incorporate these voices, using feedback to continually improve service delivery and create environments that feel safe, affirming, and responsive to transgender clients’ needs (Singh, Hays, & Watson, 2011).

For therapists and treatment programs, this approach could involve forming advisory boards that include transgender community members, regularly surveying clients for feedback, or engaging in open dialogues with transgender clients about how to tailor services to better meet their needs. When transgender voices are central to treatment development, it creates a more accurate, compassionate, and effective framework for supporting their journey toward healing and self-acceptance.

Conclusion and Call to Action

The journey to recovery from an eating disorder is deeply personal, complex, and challenging for anyone. For transgender adults, this journey is further complicated by unique challenges—gender dysphoria, societal pressures to conform to binary gender ideals, minority stress, and a healthcare system that often lacks trans-affirming options. Each of these factors can influence body image, self-perception, and eating behaviours, highlighting the critical need for care that is gender-affirming, trauma-informed, and intersectional.

A supportive treatment approach recognizes the significance of each individual’s gender identity, addresses past traumas, and fosters resilience by celebrating the strengths clients bring to their healing process. As clinicians, allies, and advocates, it is our responsibility to create a space where transgender individuals feel seen, respected, and empowered. By advancing inclusive research, advocating for equitable policies, and actively including transgender voices in the design of treatment programs, we can work together to build a healthcare landscape that truly honours and supports the diversity within the transgender community.

If the ideas shared in this blog resonate with you, I warmly invite you to connect with me at Clayre Sessoms Psychotherapy ULC. Whether you’re a therapist seeking guidance on providing trans-affirming care or someone navigating your own healing journey, know that support is available. Together, we can work towards a future where each individual, regardless of gender, can access compassionate and inclusive mental health care.

Continue the Convo

If this blog post speaks to you, I welcome you to connect with me. Whether you’re a therapist committed to offering gender-affirming care or someone seeking support for eating disorders and related challenges, I’m here to help. You may book individual therapy sessions or peer consultations online. And, be sure to bookmark this blog for future insights, reflections, and updates.

References

•Chang, S. C., Singh, A. A., & Dickey, L. M. (2018). A clinician’s guide to gender-affirming care: Working with transgender and gender nonconforming clients. New Harbinger Publications.

•Counihan, C. M. (1999). The anthropology of food and body: Gender, meaning, and power. Routledge.

•Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241-1299.

•Dalzell, E., & Protos, M. (2020). Food and gender: Identity and power. Routledge.

•Erickson-Schroth, L. (Ed.). (2014). Trans bodies, trans selves: A resource for the transgender community. Oxford University Press.

•Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.

•Richmond, K., Burnes, T., Singh, A., & Ferrara, T. (2017). Development and initial evaluation of the trans-affirmative therapeutic relationship self-efficacy scale. Psychology of Sexual Orientation and Gender Diversity, 4(1), 75-86.

•Singh, A. A., Hays, D. G., & Watson, L. S. (2011). Strength in the face of adversity: Resilience strategies of transgender individuals. Journal of Counseling & Development, 89(1), 20-27.