Literature Review
For a serious and objective approach to the purpose of the study, sources related to the topic of eating disorders in transgender people were examined. Currently, society is very much evolving in terms of tolerance and attention to minority issues, including gender-specific groups. Due to this factor, a significant part of the research has appeared in the past few years, including work on identifying causes and attempting to address eating disorders. Most of the material studied focuses on young people as the more problematic stratum in percentage terms. However, papers analyzing other age groups were likewise selected to maximize exposure.
A total of 49 articles were reviewed, including e-journals, books, and journalistic publications in open resources like libraries or news websites. As a result, 12 significant writings were selected, with preference given to peer-reviewed sources to maximize the validity of the conclusions in the analysis. The literature review section compares key components of approaches to the causes, course, and consequences of eating disorders among transgender people.
Eating Disorders in the LGBT Population
The common problem on which all of the selected sources focus is the increased rate of eating disorders, most of which are caused by stress among gay, lesbian, bisexual, and transgender people. Some papers focus exclusively on transgender people having the highest eating disorder rate among the entire LGBT community (Bell et al., 2018; Parker & Harriger, 2020; Uniacke et al., 2021). Eating disorders refer to a feature of behavior change in which a person disrupts or interrupts standard eating behaviors while experiencing related negative emotions or feelings. Such disorders can have a severe impact on a person’s social, psychological, or physical state and functioning and have unpredictable negative consequences.
Key Concepts, Theories, and Studies
Most authors agree on the exact central definition of causes. For example, Bell et al. state that most diagnostic findings in eating disorders demonstrate concern about shape and weight as the underlying cause (2018). Thus, a self-esteem disorder on this basis can lead to episodes of overeating or malnutrition, overly strict diets, starvation, or inadequate nutrient intake.
Such disorders raise a further problem – compensatory patterns in the behavior. Many authors include in these concepts the abuse of diuretics, laxatives, and other medications or harmful dietary supplements, self-induced vomiting, or compensatory physical overload with general frailty (Bell et al., 2018; Nagata, Ganson, et al., 2020; Testa et al., 2017). The occurrence of bulimia nervosa or anorexia nervosa has been reported in a large number of cases in transgender men and women (Duffy et al., 2019; Gordon et al., 2021). The rate of such disorders fluctuates in the LGBT population, but it is immeasurably higher than in the cisgender population.
The main theories are the determination of the underlying cause, and here, opinions are somewhat divided. According to Nagata and Murray et al., a key role in the development of the described conditions and other eating disorders is played by dissatisfaction with one’s body, a failure to conform to one’s ideas about its shape (2020). Many disorders can be caused by the pursuit of ideal images of gender identity or the desire to reduce the association with the sex assigned at birth, for example, a decrease in the expressiveness of the secondary sex characteristics (Nagata, Murray, et al., 2020). There is likewise the problem of separating disordered eating from the specific precursor of a gender-oriented eating disorder.
The second leading theory, according to Nowaskie, can be blamed on sociocultural pressures of society in addition to gender dysphoria (Nowaskie et al., 2021). This idea occurs and is highlighted by many other sources (Bell et al., 2018; Coelho et al., 2019; Gordon et al., 2021). The implication is the negative influence of others on the psychological state of the transgender person. This influence can include bullying as well as denial and rejection in society, not necessarily experienced personally (Bell et al., 2018). Furthermore, sociocultural pressure can include stereotyped images of gender identity, through which this theory connects and interacts with the first theory.
Key studies were conducted at different times on multi-age samples, most of which had insufficiently large numbers of representatives of the transgender community. Thus, in almost all of the sources studied, one of the problems is the lack of clinical and statistical data (Parker & Harriger, 2020). This problem will be discussed in more detail in the following sections. In most studies and surveys, the basis was an eating disorder research questionnaire, the original of which is designed exclusively for cisgender people (Nagata, Ganson, et al., 2020).
Through the analysis of several sources, several significant observational findings can be highlighted. According to the statistics, the average rates of dietary restriction are higher among transgender women than among transgender men of the same age categories (Nagata, Murray, et al., 2020). Correspondingly, compensatory behaviors of physical overload or intentionally induced vomiting are less common among them (Hartman-Munick et al., 2021; Parker & Harriger, 2020; Uniacke et al., 2021). However, the difference in observational findings varies from study to study within the chosen population itself and is considerable when compared to other members of the LGBT population.
Moreover, given the extensive number of studies conducted on young transgender persons, the second theory about sociocultural pressures highlighted becomes apparent. Adolescents are disproportionately more likely to experience bullying and intolerant environments than older members of the survey groups (Coelho et al., 2019). This finding draws attention to the importance of finding not only medical and psychological means to find the best resolution to the problem but to involve the social, humanitarian, and educational components of society as well.
Proposed Study’s Position on Debatable Evidence
Controversial evidence includes the heterogeneity of the scoring systems used by researchers. This study assumes that only through the unification of research methods and questionnaires is it possible to obtain the most accurate data. Accordingly, the results will be the most reliable when analyzing such data. The use of questionnaires for cisgender patients cannot be an entirely correct step (Nagata, Murray, et al., 2020). Moreover, changes in the details of such questionnaires must be forced at the state legislative level in order to get results.
As for the age limits, there is enough ambiguity in the process of their definition as well. The claims of Avila et al. and Coelho et al., whose works focus primarily on transgender youth, are contentious (2019). According to their version, many problems are shaded brighter and more prominent precisely in samples of people under 20-22 years of age (Avila et al., 2019; Coelho et al., 2019). However, psychological deterioration and subsequent potential eating disorders among the older generation should not be neglected (Bell et al., 2018). The midlife crisis, aging psychic issues, and related societal problems for transgender people are no less critical statistically than levels of bullying among transgender youth.
Controversies Surrounding the Research
The prominent and most notable controversy is the inconsistency of research findings. For example, the final data can differ immensely in a number of similar surveys, with similar methodology and age selection. For example, the Bell et al. surveys suggest a significant difference in EDE-Q scores between transgender men and women (2018). In contrast, in the various analyses, this distinction is much smaller (Nagata, Murray, et al., 2020). It is highly possible, in this case, that this situation may occur due to a general lack of data.
In addition, the same need for further research is repeated in virtually all of the sources that have been studied. It is crucial to develop specific methods and tools of analysis for diagnosing eating behavior disorders and identifying related and following problems (Coelho et al., 2019). Furthermore, two countervailing views can be identified in the discussion of the issue: focusing on finding the best method of prevention or on the timely identification of symptoms and their treatment together with the consequences (Hartman-Munick et al., 2021; Parker & Harriger, 2020). The best in this situation can be considered combining such developments to eliminate the situation as a whole.
Gaps in the Existing Knowledge
Two major gaps can be found in the existing data today, and methods for closing them can be proposed. The first of these techniques relates specifically to the lack of data and the ensuing interconnected problems of validity, estimation, and the overall meaning of the analysis (Uniacke et al., 2021). At the same time, the situation is possibly aggravated by the psychological state of those observed, which in most cases, is corrupted by sociocultural and other pressures (Bell et al., 2018; Parker & Harriger, 2020). When completing information, people with a defeatist attitude may successfully conceal some information or provide untruthful data for fear of being disrespected.
Among other missing knowledge, researchers cannot have information about what percentage of all transgender people can hide the fact that they have eating problems and may end up at the doctor’s office already in poor condition with severe health issues. In addition, specialists do not always monitor hormone therapy, and a large percentage of transgender people are not consulted by professionals (Parker & Harriger, 2020). They can make a critical statistical amount of diseases within the transgender population, including eating disorders, the percentage of which is high among LGBT people, and many other potential health problems.
The second fact of the data absence relates to the researchers’ focus on specifying research findings rather than seeking knowledge about solutions to eating disorders among transgender people. The process of gathering information itself needs to be anonymized as much as possible in order to create as large a sample as possible and offer a workable solution to the problem (Nagata, Murray, et al., 2020; Nagata, Ganson, et al., 2020). So far, unfortunately, the majority of researchers mostly recommend pinpointing psychological and physiological help (Parker & Harriger, 2020). However, an understanding of the need for some specific action to reduce the overall percentage of such disorders in society is needed.
References
Avila, J. T., Golden, N. H., & Aye, T. (2019). Eating disorder screening in transgender youth. The Journal of Adolescent Health, 65(6), 815–817. Web.
Bell, K., Rieger, E., & Hirsch, J. K. (2018). Eating disorder symptoms and proneness in gay men, lesbian women, and transgender and non-conforming adults: Comparative levels and a proposed mediational model. Frontiers in Psychology, 9, 2692. Web.
Coelho, J. S., Suen, J., Clark, B. A., Marshall, S. K., Geller, J., & Lam, P.-Y. (2019). Eating disorder diagnoses and symptom presentation in transgender youth: A scoping review. Current Psychiatry Reports, 21(11), 107. Web.
Duffy, M. E., Henkel, K. E., & Joiner, T. E. (2019). Prevalence of self-injurious thoughts and behaviors in transgender individuals with eating disorders: A national study. The Journal of Adolescent Health, 64(4), 461–466. Web.
Gordon, A. R., Moore, L. B., & Guss, C. (2021). Eating disorders among transgender and gender non-binary people. In Eating Disorders in Boys and Men (pp. 265–281). Springer International Publishing.
Hartman-Munick, S. M., Silverstein, S., Guss, C. E., Lopez, E., Calzo, J. P., & Gordon, A. R. (2021). Eating disorder screening and treatment experiences in transgender and gender diverse young adults. Eating Behaviors, 41(101517), 101517. Web.
Nagata, J. M., Ganson, K. T., & Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities. Current Opinion in Psychiatry, 33(6), 562–567. Web.
Nagata, J. M., Murray, S. B., Compte, E. J., Pak, E. H., Schauer, R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., & Obedin-Maliver, J. (2020). Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women. Eating Behaviors, 37(101381), 101381. Web.
Nowaskie, D. Z., Filipowicz, A. T., Choi, Y., & Fogel, J. M. (2021). Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation. The International Journal of Eating Disorders, 54(8), 1493–1499. Web.
Parker, L. L., & Harriger, J. A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. Journal of Eating Disorders, 8(1), 51. Web.
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: Official Journal of the Division of Health Psychology, American Psychological Association, 36(10), 927–936. Web.
Uniacke, B., Glasofer, D., Devlin, M., Bockting, W., & Attia, E. (2021). Predictors of eating-related psychopathology in transgender and gender nonbinary individuals. Eating Behaviors, 42(101527), 101527. Web.