Reasons Eating Disorder Center puts a strong emphasis on creating an eating disorder treatment environment that feels safe, inclusive and effective for all. We are passionate about and committed to creating access to treatment for marginalized communities. With that in mind, we are thrilled to announce our blog collaboration with Jamie (OJ) Bushell of thirdwheelED. Jamie is a mental health and eating disorder recovery advocate, a writer and the co-creator of thirdwheelED. ThirdwheelED serves as a platform to increase visibility of how eating disorders impact the often-marginalized LGBTQ+ community and creates space to participate in advocacy work through storytelling. OJ will be joining us on the Reasons blog from time to time to share their insights and perspective into eating disorder treatment and recovery within the LGBTQIA+ community. Please join us in welcoming OJ to the Reasons blog and read on for their perspective!
Eating disorders disproportionately impact marginalized folks, including transgender and gender non-conforming individuals. Research shows that transgender college students are four times as likely to report an eating disorder diagnosis than their female, cisgender, and heterosexual peers (Diemer et al., 2015). Additionally, sexual and gender minority college students have higher rates of self-diagnosis and are more likely to engage in compensatory behaviors such as diet pills and laxatives (Simon et al., 2020).
Many factors contribute to this community’s higher prevalence of eating disorders, including experiences of discrimination, harassment, and potentially unstable home environments. Some transgender and gender non-conforming folks experience gender dysphoria and increased body image distress, which can lead to co-occurring mental health conditions (such as anxiety and depression) that can support the development of eating disorders.
While transgender and gender non-conforming folks have the highest rate of eating disorders, they often also experience immense difficulty accessing treatment. They may never seek out eating disorder treatment because of a lack of access, knowledge about treatment, and financial ability. While cisgender counterparts often experience these barriers, too, transgender and gender non-conforming folks face the additional compounding variable of finding a treatment center that is not only gender inclusive, but also gender affirming.
Most likely, transgender and gender non-conforming folks seeking eating disorder treatment have already faced discrimination in their lives prior to treatment (e.g., bullying, trauma, violence). Seeking eating disorder treatment can feel especially difficult and frightening if you’re concerned you might experience these acts of violence again.
From experience, I can tell you that even when transgender and gender non-conforming folks do seek eating disorder treatment and recovery support services, these experience may negatively impact one’s recovery. From suffering microaggressions to experiencing a lack of gender-affirming care, transgender and gender non-conforming folks often obtain treatment that is not specific to their individual needs. Sometimes these encounters result from a provider’s lack of experience or education working with transgender and gender non-conforming communities. Regardless though, harm is done.
So, if you are seeking eating disorder treatment, how do you choose a treatment center that is inclusive and gender-affirming? Acceptance into a treatment program is not enough. It’s important to determine if the eating disorder treatment center understands your unique experiences and the complexities of being transgender and gender non-conforming. Here are five questions you should ask a treatment center, or consider for yourself, as you begin the intake process:
- What are your housing provisions for transgender and gender non-conforming folks? Some treatment centers will room based on sex assigned at birth or automatically put folks in single rooms. Learn ahead of time what type of rooming situation you can expect. Knowing this information upfront can help you advocate for yourself if needed (not that you should have to).
- Do you have gender neutral bathrooms? If the answer to this question is “no,” ask how the bathrooms are labelled and who can access them. Are there single stall bathrooms? Multi-stall? Use this information to make an informed decision about whether you feel safe with the options.
- How much training has your staff received about LGBTQIA+ communities in general and around eating disorders specifically? You can also inquire further by asking how often they receive these trainings and who receives the trainings. All staff, including executives, administrative roles, clinical roles, and frontline staff should receive this training.
- How do you handle microaggressions when they occur? Eating disorder treatment already can feel scary and overwhelming. It’s important that you feel safe enough to open up and engage in vulnerability. If you are misgendered by a clinician, it has the potential to impact and even curtail your recovery progress. Asking the treatment center how they facilitate dialogue around these experiences can help you feel safer as you prepare to begin treatment.
- Does the admissions/intake coordinator ask me about my gender? The answer to this question could help determine if all staff have received training about LGBTQIA+ communities. If they don’t ask, then chances are they haven’t been trained. You may also consider how they ask you about your gender. Do they ask about it in a way that feels respectful and knowledgeable?
The impact of gender-affirming care is not small. One study found that transgender folks who received gender-affirming medical interventions experienced fewer experiences of non-affirmation, improved body satisfaction, and lower eating disorder symptomatology (Testa et al., 2017). While not all transgender or gender non-conforming individuals desire medical interventions, this study underscores that it’s possible to reduce eating disorder symptoms by increasing access to gender-affirming care. Even though finding gender affirming care can be challenging, seeking eating disorder treatment that respects one’s identities and individualized needs is essential for long-term recovery.
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144-9.
Simonne, M., Askew, A., Lust, K., Eisenberg, M. E., & Pisetsky, E. M. (2020). Disparities in self-reported eating disorders and academic impairment in sexual and gender minority college students relative to their heterosexual and cisgender peers. International Journal of Eating Disorders, 53(4), 513-24.
Testa, R. J., Rider, G. N., Haug, N. A., & Balsam, K. F. (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology, 36(10), 927-936. https://doi.org/10.1037/hea0000497