In this case study, the eating disorder was closely connected to gender dysphoria, although transition did not cure it. The patient’s life history may also have contributed to her eating disorder.
The patient was a 25 year old trans woman (born male) in New Zealand. Her eating disorder began when she started living as a woman at age 15. The goal of her restricted eating and purging was to have a more feminine shape and attract men. When she tried to live as a man for six months, her symptoms decreased.
The patient was a survivor of physical and sexual child abuse. She ran away from home and school before she was 15* and at 16 she was hospitalized for self-harm. She had had short and often violent relationships with men. She was currently unemployed, but had worked in the hospitality industry and as a self-employed escort.
Transition did not cure her eating disorder. She was taking hormones and living as a woman when she came to the clinic for eating disorders. According to the clinicians, she had a “convincing female appearance.”
Treatment is hard to evaluate in this case, however, because the patient did not want to stop her restricted eating and vomiting. Instead, she asked about more efficient ways to change her shape.
It is important to remember that this is just a case study of one individual; the relationship between eating disorders and gender dysphoria is complicated. The main conclusion I have reached in looking at case studies is that each person’s story is different.
However, like the patients in this study and this one, her restricted eating and purging began when she decided to live as a woman. For some trans women, eating disorders are clearly linked to gender dysphoria.
The patient also had a history of trauma like one of the patients in this case study. Trauma may also be a factor in eating disorders for some trans people.
The authors conclude that gender dysphoria may be a risk factor for eating disorders in trans women.
By virtue of its emphasis on estrangement from body, transgendered individuals may experience heightened body dissatisfaction and excessive concern with appearance. Accordingly, in certain men, transgenderism may constitute a risk factor for developing an eating disorder. In particular, the presence of a history of otherwise known predisposing risk factors including dieting, a family history of obesity, and significant adverse life events may alert clinicians to more closely screen for an eating disorder among the transgendered population seeking psychiatric consultation.
More details about her eating disorder:
“Although of normal weight (body mass index = 23), she was significantly dissatisfied with her shape, and closer analysis revealed a wish for larger breasts, smaller hips, and a more ‘feminine shape’ overall. She frequently checked her profile in mirrors and took delight in discovering when clothes had become baggy to wear, although adamantly denied attachment to the goal of weight loss per se. Rather, she reported significant anxiety around the sensation of food in her stomach, believing that men might perceive her as a less desirable partner if she had a protruding stomach or midriff. Currently she cited this as the main cue to purge. In further pursuit of a more feminine shape, her ambition was to attain improved muscle tone by walking up to 33 km per day.”
More details about her gender dysphoria and life history:
The patient had experimented with cross-dressing in early childhood. She felt like an outcast at school, especially after she was singled out for being too feminine.
She had not had surgery because she could not afford it.
Her family had a history of obesity, but not eating disorders. According to the authors, they did not have psychiatric problems.**
*It’s not clear to me if she returned home after running away or not.
** Except for the bit about the child abuse.