Eating disorders in transgender and gender diverse people: characteristics, assessment, and management

Exploring the Extent and Nature of Disordered Eating Among Canadian Adolescents and Young Adults With Spina Bifida and Hydrocephalus

BACKGROUND

Adolescents and young adults (AYA) with spina bifida and/or hydrocephalus (SBH) are at a higher risk for disordered eating, poor body image and body dissatisfaction. Regrettably, there is limited research on the eating patterns and behaviours of AYA with SBH, as well as their body image perceptions.

OBJECTIVES

The purpose of this study was to explore the nature of disordered eating behaviours among AYA with SBH and their perceptions surrounding their body image. This study represents the first investigation of its kind conducted within a Canadian population. It fills a literature gap regarding the understanding of disordered eating behaviours and body image perceptions among young individuals with SBH in Canada.

METHODS

The study comprised a self-report, cross-sectional online survey of AYA with SBH across Canada. The survey comprised validated brief measures to evaluate eating behaviours, disordered eating and body esteem. AYA aged 12-26 years with any type of SBH were eligible to participate.

RESULTS

Twenty-four participants were recruited. Results indicated that AYA with SBH may face an elevated risk for eating disorders/disordered eating compared to their typically developing peers, due to a myriad of reasons not typically experienced in the general population such as bowel and bladder management, mobility issues and eating aversions. Findings also indicated that some AYA with SBH may have poor body image and that it is possible that this is not discussed in SBH clinics.

CONCLUSION

Our work underscores the urgency for further research that focuses on assessing eating disorders/disordered eating behaviours in AYA with SBH.

Associations Between Gender Diversity and Eating Disorder Symptoms in Early Adolescence

OBJECTIVE

To assess associations between multiple dimensions of gender diversity with eating disorder symptoms in a national cohort of U.S. early adolescents.

METHOD

This cross-sectional study utilized data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,092, M age  = 12.9 years, 2019-2021). Gender diversity was measured using multiple dimensions, including categorical gender identity (e.g., transgender, cisgender), categorical and continuous felt gender (congruence between gender identity and assigned sex), ordinal gender non-contentedness (dissatisfaction with one's gender), and ordinal gender expression (communication of gender through appearance and mannerisms). Multivariable logistic regression models were used to analyze the associations among gender diversity measures and eating disorder symptoms, adjusting for potential confounders.

RESULTS

Greater felt gender diversity was associated with self-worth tied to weight (OR 1.30, 95% CI 1.11-1.53), binge eating (OR 1.24, 95% CI 1.06-1.46), and distress with binge eating (OR 1.32, 95% CI 1.09-1.59). Greater gender expression diversity was associated with self-worth tied to weight (OR 1.16, 95% CI 1.02-1.33), distress with binge eating (OR 1.26, 95% CI 1.04-1.51), and characteristics of binge eating episodes (OR 1.33, 95% CI 1.06-1.66). Gender non-contentedness was associated with self-worth tied to weight (OR 1.38, 95% CI 1.20-1.58) and compensatory behaviors related to weight gain (OR 1.12, 95% CI 1.01-1.26). Transgender identity was not significantly associated with any eating disorder symptoms.

DISCUSSION

We found that greater gender diversity across multiple dimensions was associated with various eating disorder symptoms, and that measures beyond binary gender identity may be important to assess gender diversity in early adolescence.

Investigating Eating Symptoms in the LGBTQIA+ Population: Do Discrimination and Adverse Conditions Matter?

BACKGROUND

Eating disorders (EDs) have traditionally been studied among heterosexual cisgender women, but recent research highlights a higher prevalence in LGBTQIA+ individuals.

AIMS

This study aims (1) to investigate the association between different groups based on gender identity and sexual orientation (GISO) and experiencing eating symptoms, and (2) to explore the extent to which self-perceived discrimination and adverse conditions explain this association.

METHODS

We administered an online survey to assess eating symptoms using the Eating Disorder Examination Questionnaire (EDE-Q 6.0) and measures of self-perceived discrimination and adverse conditions. Multistep logistic regressions were employed to analyze the associations between GISO and eating symptoms, initially unadjusted, then adjusted for sociodemographic variables, and finally adjusted for self-perceived discrimination and/or adverse conditions.

RESULTS

A total of 560 adults aged 30 ± 10.9 years old were included. After adjusting for socio-demographics all groups were more likely to experience eating symptoms compared to heterosexual men, with odds ratios (ORs) of 5.7 [95% CI: 1.3, 24.3] for cisgender heterosexual women, 6.7 [95% CI: 1.5, 29.8] for cisgender non-heterosexual women, and 9.3 [95% CI: 1.8, 47.5] for non-cisgender individuals. After adjusting for self-perceived discrimination and adverse conditions, the associations for women were attenuated, while the associations for non-cisgender individuals were no longer significant.

CONCLUSION

This study (1) confirms that sexual and gender minorities may be at higher risk for EDs, and (2) suggests that discrimination and adverse conditions may contribute to the higher prevalence of eating symptoms in this population. Additional research is needed to investigate these minority stressors as they may represent targets for effective interventions to prevent eating symptoms in the LGBTQIA+ community.

Eating disorders: etiology, risk factors, and suggestions for prevention

PURPOSE OF REVIEW

The incidence of eating disorders has increased worldwide. This narrative review gives an overview of research on etiology and risk factors of eating disorders published in 2022-2024.

RECENT FINDINGS

Eating disorders arise from a complex set of risk factors. The recent increase in incidence of eating disorders can be linked to root causes that include sociocultural pressure to conform to unrealistic and gendered body ideals, rise in obesogenic environments, and the global COVID-19 pandemic. Recent studies have shown that screen time and social media intensify sociocultural pressure to look a certain way. Individual-specific risk factors also increase the likelihood of onset of eating disorders. These include sports, stressful and traumatic life events, family factors, and psychological factors, including disgust sensitivity, aversive experiences, low self-esteem, perfectionism, neuroticism, obsessive-compulsive and impulsive features, and emotional dysregulation. Preexisting mental health conditions, particularly anxiety, depression, and posttraumatic stress disorder, and neurodevelopmental conditions, such as autism and attention-deficit hyperactive disorder, are also associated with increased eating disorder risk. Genetic and biological factors contribute both to risk and resiliency.

SUMMARY

The risk factors of eating disorders are well established. Future studies should focus on increasing resilience and preventive interventions.

Sex and gender considerations in cross-cultural traumatic stress studies

Following the 1st Conference of the Global Collaboration on Traumatic Stress, the consortium committed to systematically integrating sex and gender considerations in their endeavours, which aligns with the European Journal of Psychotraumatology's Gender Policy. This initiative is vital for understanding trauma's complex impacts, but also presents significant challenges in cross-cultural research. This letter, co-authored by researchers from across the globe, outlines these challenges and proposes mitigation strategies. First, definitions of sex and gender are provided from a Western perspective, while acknowledging cultural differences in these concepts. Second, the relevance of integrating sex and gender considerations in traumatic stress studies is briefly described. Third, cultural distinctions and legal contexts shaping the understanding and inclusion of these concepts, with non-Western and low-to-middle income regions facing significant legal and ethical obstacles are highlighted. Methodological challenges including measurement, recruitment, and statistical modelling are discussed, followed by recommendations including participatory approaches that involve members of the community, including sexual and gender minority individuals, as possible, throughout the research process, conducting risk analyses, employing sensitive quantitative and qualitative methods, and ensuring clear reporting and participant protection. To conclude, with this letter, we hope to instigate dialogue and foster innovative approaches to incorporating sex and gender considerations in cross-cultural studies of traumatic stress. Addressing these considerations is essential for ethical, meaningful research that respects and safeguards diverse experiences.

Understanding the Social Drivers for LGBTQIA+ Youth Suicide

LGBTQIA+ youth are disproportionately affected by mental health issues including suicidal ideation and suicide attempts. Minoritized youth have numerous social and structural factors influencing their health, including a lack of access to care and resources. However, these youth and their caregivers also have many unique and individual cultural strengths. Awareness of special considerations and work toward dismantling structural drivers is essential in improving the health of these youth. Additionally, it is important to support minoritized youth and their caregivers through tailored evidence-based treatments in addressing social and structural drivers to influence individual, community, educational, institutional, and policy levels and prevent suicide in achieving mental health equity.

New understandings meet old treatments: putting a contemporary face on established protocols

In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.