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Transgender populations are disproportionately impacted by eating 
disorders and disordered eating behaviors; however, transgender clients 
lack access to affirming and culturally responsive mental health care and 
are frequently undiagnosed. In addition, conventional treatment models 
for eating disorders do not attend to the unique causes and manifestations 
of  eating disorders among transgender people, which include: minority 
stress and gender trauma; gender dysphoria and lack of  access to safe, 
gender-affirming treatment; safety concerns and the need for passing; 
cissexism and resulting disempowerment; and pervasive, harmful beauty 
standards coupled with hyper-scrutiny of  trans bodies. This project 
includes a summary and analysis of  the existing literature and data 
regarding the causes of  and current treatment recommendations for 
eating disorders within transgender populations. It also suggests a social-
work-led shift within eating disorder treatment to center the sociopolitical 
forces which so often lead to such diagnoses. 

Keywords: transgender, eating disorder, culturally responsive treatment, 
minority stress, gender trauma, access to care, cissexism, anti-oppressive 
approach

Unique Causes and Manifestations 
of Eating Disorders Within 
Transgender Populations

SULA MALINA
THEY,THEM



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EATING DISORDERS WITHIN TRANSGENDER POPULATIONS

UNIQUE CAUSES AND MANIFESTATIONS OF EATING 
DISORDERS WITHIN TRANSGENDER POPULATIONS 

Despite limited representation of  transgender bodies in both 
popular media and a lack of  attention in clinical training to transgender 
concerns, research over the past several decades has indicated a high 
prevalence of  eating disorders (EDs) and disordered eating behaviors 
among transgender populations. Research on health outcomes 
among transgender people and research on eating disorders are each 
underfunded (Feldman et al., 2016; Murray et al., 2017); few studies have 
been published on the intersection of  the two that are generalizable at 
a population level. Those which do exist have focused nearly exclusively 
on transgender youth. A 2015 study of  289,024 students from 233 U.S. 
universities revealed that 15.8% of  trans respondents had been diagnosed 
with an eating disorder, compared to 1.85% of  cisgender, heterosexual 
women, and 0.55% of  cisgender, heterosexual men (Diemer et al., 2015). 
The study also collected data on reported disordered eating behaviors 
among participants within the past month: 13.5% of  trans respondents 
reported using diet pills within the past month, compared with 4.29% of  
cisgender, heterosexual women. Futhermore, 15.1% of  trans respondents 
reported self-induced vomiting or laxative use within the past month, 
compared to 3.71% of  cisgender, heterosexual women (Diemer et al., 
2015). In collecting symptom-specific data, Diemer et al. identified 
behaviors in individuals who may not have received a formal diagnosis 
at the time of  data collection due to either their nature or duration. 
Other Specified Feeding and Eating Disorder (OSFED) is generally 
considered more common among transgender people than the more 
widely recognized diagnoses of  anorexia nervosa and bulimia nervosa, 
due to the unique manifestations of  disordered eating motivations and 
behaviors among trans populations. A 2015 study of  gender identity, 
sexual orientation, and self-reported ED diagnoses among college 
students (N=289,024) found that trans respondents (n=479) were more 
likely to report disordered eating behaviors generally, and particularly 
those consistent with a diagnosis of  OSFED (Diemer et al., 2005). Other 
researchers have importantly identified that mortality rates for Eating 

Disorders Not Otherwise Specified (the DSM-IV diagnosis later renamed 
OSFED in the DSM 5) are comparable to those for bulimia nervosa 
(Arcelus, 2011); thus OSFED is no less dangerous than the well-known 
diagnoses. 

Though exact rates vary across research studies, the general trend 
of  higher rates of  EDs among trans respondents are consistent. A 2016 
study of  218 children and adolescents with gender dysphoria revealed 
that 13.3% had “eating difficulties” (Holt et al., 2016), and a 2012 study 
of  97 youth with “gender identity disorder” (a DSM-IV diagnosis which 
later became “gender dysphoria” in the DSM 5) demonstrated a 7% rate 
of  EDs among its sample (Spack et al., 2012). Dangerously little research 
has been published on the experiences of  transgender people of  color 
(POC) navigating eating disorders. Indeed, only 30.42% of  respondents 
(including only 4.5% Black and 5.96% Latinx) to the 2015 study (Diemer 
et al., 2015) and 11.3% of  respondents to the 2016 study (Holt et al., 
2016) were POC. Of  the former, only 4.5% of  respondents were Black 
and 5.96% were Latinx; the remainder of  the 30.42% were comprised of  
Asian American Pacific Islander (AAPI), multiracial, Native American, 
and “unknown” respondents (Diemer et al., 2015). Spack et al. (2012) did 
not include data around participant race and ethnicity, likely indicating a 
lack of  attention to inclusive participant recruitment, and a fairly racially 
homogenous sample by extension. In spite of  this, high rates of  eating 
disorders among BIPOC populations suggest that rates among trans 
people of  color may be even higher (NEDA, 2018). 

These statistics are cause for alarm, not only because of  their 
contrast to data on cisgender youth, but because of  the considerable 
dangers associated with eating disorders. EDs have “the highest rates 
of  related medical complications, hospitalizations, and mortality of  all 
psychiatric disorders” (Duffy et al., 2016, p. 136).   This paper seeks 
to explore the extent to which eating disorders among transgender 
populations are influenced by sociopolitical forces. Social workers, who 
are trained to use an anti-oppressive, “social model” of  mental health, 
are uniquely positioned to advocate and provide affirming interventions 

SULA MALINA



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EATING DISORDERS WITHIN TRANSGENDER POPULATIONS

for transgender clients. Clinicians must consider five major contributing 
factors to eating disorders among transgender populations: 1) minority 
stress and gender trauma, 2) gender dysphoria and lack of  access to safe, 
gender-affirming treatment, 3) safety concerns and the need for passing, 
4) cissexism and resulting disempowerment, and 5) pervasive, harmful 
beauty standards coupled with hyper-scrutiny of  trans bodies. 

MAJOR CONTRIBUTING FACTORS
DISCRIMINATION-BASED STRESS AND GENDER TRAUMA

Minority stress was first introduced in 2003 to describe the result 
of  repeated exposure to microaggressions and other forms of  stigma 
and discrimation among lesbian, gay, and bisexual (LGB) individuals. 
Epidemiologist Ilan H. Meyer found that high levels of  stress were 
associated with negative mental health outcomes (Meyer, 2003). The 
concept has since been expanded to other marginalized populations, 
including Black and Indigenous People of  Color (BIPOC), transgender 
communities, and disabled people, among others. Experts recognize 
that the experience of  transgender embodiment within a cissexist 
society precipitates gender trauma and stress (Kosciewicz et al., 2020). 
Moreover, for transgender POC this trauma is compounded by the 
violence of  racism (Harrington, et al., 2006). Researchers have identified 
a relationship between stress, trauma, and maladaptive coping strategies 
such as disordered eating (Witcomb et al., 2015, p. 292); high rates of  
such behaviors and disorders among a population so vulnerable to stress 
and trauma are, unfortunately, unsurprising. 

Despite limited research, there is significant evidence to suggest that 
the risk of  disordered eating among trans people of  color is heightened 
due to the compounding nature of  marginalized identities and 
oppression. Legal scholar Kimberlé Crenshaw introduced the concept of  
intersectionality in 1991, noting the unique experience of  those living at 
the intersection of  multiple marginalized identities, and, consequently, 
subjugated by multiple systems of  oppression. As Crenshaw writes, “the 
intersectional experience is greater than the sum of  racism and sexism” 
(Crenshaw, 1991, p. 58). Thus, navigating an eating disorder becomes 

more complex for a transgender person of  color than for a white or 
cisgender person. 

GENDER DYSPHORIA AND LACK OF ACCESS TO SAFE,  
GENDER-AFFIRMING TREATMENT

 Some transgender people experience gender dysphoria: a state of  
distress caused by the misalignment between their own gender identity 
and that which is associated with their sex assigned at birth. While the 
DSM 5 and the World Professional Association of  Transgender Health 
(WPATH) Standards of  Care recommend gender-affirming medical 
intervention such as hormone therapy and surgeries as treatment for 
gender dysphoria, lack of  access to affirming care as well as limited effects 
of  interventions may lead trans individuals to physically “transition” 
through disordered eating behaviors. For many transgender people, 
disordered eating can be seen as a method of   “either suppressing or 
accentuating gender by changing the shapes of  their bodies” (Kosciewicz 
et al., 2020, p. 73). For those assigned female at birth, this may mean 
weight loss to reduce hips, breasts, or buttocks, while those assigned male 
at birth may gain weight to de-emphasize shoulder breadth, among other 
characteristics (Kosciewicz et al., 2020). Transmasculine individuals 
(those assigned female at birth who are transgender and who identify 
with masculinity to a greater extent than femininity) may restrict their 
diet to induce amenorrhea, or the cessation of  menses (Testa et al., 2017). 
As Chang et al. (2018) acknowledges, these behaviors, while dangerous, 
“may feel more accessible or actionable’’ than physical transition by 
medical means (p. 116). 

 Barriers to accessing gender-affirming care may fuel the desire to 
participate in harmful disordered eating behaviors. Financial limitations 
may include lack of  health insurance coverage, high out-of-pocket 
cost of  care, and limited free time in which to seek care. Geographic 
restrictions may also create challenges to accessing a gender-affirming 
provider in close proximity. Finally, lack of  support in familial/peer 
relationships and potential safety risks in altering one’s presentation and 
medical barriers, such as pre-existing conditions that might interfere 

SULA MALINA



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EATING DISORDERS WITHIN TRANSGENDER POPULATIONS

with physical transition or require a particular medical specialist, 
restrict many transgender people from accessing affirming care. 
Physical transformations by way of  disordered eating behaviors may be 
heightened among transgender POC who experience significantly more 
limited access to gender-affirming medical care, beyond that of  their 
white counterparts (Howard et al., 2019). An analysis of  the impacts of  
such barriers is explored in greater depth in the “Critique of  Current 
Treatment Model” portion of  this project. 

SAFETY CONCERNS AND THE NEED FOR PASSING

The concept of  passing was initially devised in reference to light-
skinned Black Americans who navigated anti-Black racism in the 
country by presenting themselves as white; historians trace this strategy 
back to the early years of  slavery in the United States (Hobbs, 2014). 
Passing has since been adopted by transgender communities to refer 
to the phenomenon by which transgender people are seen by others 
as cisgender people of  their affirmed gender identity. Passing has been 
rejected by many transgender activists, as to some, the term suggests 
something inherently “correct” or “successful” about appearing 
cisgender. Additionally, passing is not achievable for many people, 
depending on limitations of  hormonal and surgical transition as well 
as gender identity (one might consider what it means to “pass” as non-
binary). It should be noted that passing is not a goal for all transgender 
people, just as it has certainly not been a goal for all Black people. Many 
individuals, whether marginalized by transgender identity, race, or both, 
equate passing to a loss of  personal identity and of  community/familial 
ties (Hobbs, 2014). 

Although gender dysphoria is understood by behavioral health 
providers primarily as a mental health concern, passing as one’s 
gender identity has significant societal implications related not only 
to acceptance, but also to safety. Those “visible” as transgender are 
particularly susceptible to transphobic discrimination, including social 
othering, microaggressions, and verbal and physical harrassment and 
violence. Transgender individuals are socialized to remain hyper-

aware of  their appearance to onlookers as a matter of  survival, and 
many recognize that “biological sex characteristics related to weight 
and shape . . . may reduce how often they are perceived and treated 
as the gender they experience themselves to be” (Testa et al., 2017, p. 
928).  However, passing may precipitate greater safety risks for trans 
individuals. As activists and theorists alike note, passing as cisgender may 
be perceived as “deception” by cisgender people (Billard, 2019, p. 463). 
All too often, “deceived” cisgender people respond to the disclosure of  
another’s transgender status with rage and sometimes fatal violence. 
Passing as cisgender may be of  even greater concern to Black and 
Brown transgender women, who face an epidemic of  violence. In 2020 
alone, at least 44 transgender and gender nonconforming people, almost 
exclusively Black and/or Latinx and transfeminine, were victims of  fatal 
transphobic violence nationally (HRC, 2020). Since 2015, the Human 
Rights Campaign has recorded a total of  158 deaths (HRC, 2020; 
HRC, 2019; HRC, 2018; HRC & TPOCC, 2017; HRC & TPOCC, 
2016; HRC & TPOCC, 2015). This devastating pattern underscores the 
complexity of  the drive to “pass” (or not) for transfeminine people of  
color in particular. 

The role of  passing in driving disordered eating behaviors is 
complex. One 2018 study of  transgender adults (n=452) found a slightly 
elevated rate of  disordered eating among non-binary respondents who 
had been assigned female at birth, compared to trans men, trans women, 
and non-binary people assigned male at birth (Diemer et al., 2018). 
While researchers could not identify a clear cause for the difference, 
they noted the impact of  visible gender-nonconformity (in other words, 
“lack of  passing”) often expressed by non-binary trans people and 
the possibility that some may turn to disordered eating behaviors as a 
response to the resulting minority stress in a highly binary and conformist 
society (Diemer et al., 2018). In this sense, EDs may be employed by trans 
people either as a strategy to control the body’s shape and “pass”  
as a cisgender man or woman, or result from a manifestation of  stress 
and anxiety experienced by those who navigate the world as “un-
passable” by virtue of  their non-binary gender expression. For some,  
both factors may be at play. 

SULA MALINA



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CISSEXISM AND RELATED DISEMPOWERMENT

In response to both pervasive cissexism and gender dysphoria, 
trans people may turn to disordered eating behaviors as a means of  
reclaiming a sense of  power. As Chang et al. (2018) acknowledge, such 
behaviors may serve to “provide a sense of  control or influence over 
one’s body size or shape” (p. 116). The distress caused by a misalignment 
between internal identity and the gendered meanings attached to bodies 
in Western cultures should not be underestimated; indeed, disordered 
eating may “facilitat[e] a level of  omnipotent control in the midst of  
overwhelming and unbearable somatic feelings, and distress because of  
one’s inability to resolve the conflict between the reality of  their gender 
experience and their heavily defended-against attachment that the body 
spells as gender’s reality” (Kosciewicz et al., 2020, p. 68). Thus, the sense 
of  control some may achieve through disordered eating behaviors may 
extend beyond those behaviors’ visible impact on the shape or size of  the 
body.   

HYPER-SCRUTINY OF TRANS BODIES AND PERVASIVE BEAUTY STANDARDS

Transgender and cisgender people alike risk profound influence 
by narrow societal beauty standards, though this may be compounded 
for transgender people who are socialized into a gender role different 
from their affirmed gender and who may internalize multiple, even 
contradictory body expectations. As Witcomb et al. (2015) argue, “Trans 
males may internalize the same ideals that natal females do with regard 
to the ideal aspects of  being female, despite desiring to be male” (p. 
291). The drive for thinness may be compounded by trans identity, given 
a perceived correlation between weight loss and the “suppress[ion of] 
features of  the birth assigned gender and [accentuation of] the features 
of  the identified gender” (Witcomb et al., 2015, p. 292). Hypervisibility 
and hyper-scrutiny of  trans bodies perpetuates ideals that are even more 
extreme than those imposed upon cisgender people, “because they are 
expected to ‘prove’ themselves as being ‘man enough,’ ‘woman enough,’ 
or ‘trans enough’” (Chang et al., 2018, p. 116). These dangerous beauty 
expectations are based in whiteness, and the fatphobic standards that 

underlie them, with roots in anti-Black racism. Sociologist Sabrina 
Strings unravels the history of  fatphobia in her text Fearing the Fat Body. 
Though the current dominant culture in the United States and Europe 
justifies societal discrimination against fat bodies by deeming them 
necessarily “unhealthy,” this was not the case historically. Indeed, fatness 
historically came to be associated with “savagery” and “racial inferiority” 
amidst European colonization of  Africa (Strings, 2019, p. 4). The impact 
this history has had on Black Americans more recently is nuanced. A 
2014 series of  focus groups comprised of  Black women students (n=31) 
at a large university explored various body image concerns and values 
among participants. While all participants reported being in some way 
affected by beauty standards based in whiteness, many also reported 
that they saw “curviness” as “optimal” for Black women, and considered 
thinness to be “for white people” (Awad et al., 2016, p. 550). Regardless 
of  its manifestation, there is widespread awareness of  body image 
standards. These standards understandably impact transgender people’s 
relationships with and expectations around their body, shape, and size.  
Pressures around conforming to beauty standards are compounded 
significantly for trans POC (Johnson, 2019).

CRITIQUE OF CURRENT TREATMENT MODEL
The development of  gender-affirming, culturally responsive 

interventions for eating disorders among transgender populations 
is of  paramount importance; however, clients seeking healing face 
numerous obstacles stemming from a dearth of  competent providers, 
comprehensive research, and safe(r) community spaces. 

ACCESSING INCLUSIVE TRANSGENDER COMMUNITY

For many trans people, and especially trans youth, community 
may seem altogether nonexistent. As Davis et al. (2018) point out, 
“the absence of  trans-peers and a trans-social network can reinforce 
the maladaptive behavior that many trans-youth utilize to erase or 
reconstruct their identities” (p. 56). Even when community is available, 
the persistent stigma around eating disorders often silences communities 

SULA MALINA



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from healing through necessary conversation. This lack of  openness may 
be explained by the reality that even in their own communities, vocal 
trans people risk not only “emotional vulnerability,” but also “reveal[ing] 
the fragility of  their gender presentation” (Kosciewicz et al., 2020, p. 85). 
As in many marginalized communities, the value of  “pride” in oneself  
and one’s body in the face of  systemic violence may backfire when other 
members feel unable to acknowledge and unpack their internalized 
oppression. 

LIMITING NARRATIVES & UNDERDIAGNOSIS

Transgender people are unrepresented in the singular, dominant 
“eating disorder narrative,” which narrowly defines those with eating 
disorders as thin, white, straight, cisgender women. Consequently, 
disordered eating behaviors in trans people may go unrecognized--or 
even vehemently denied--altogether. Kosciewicz et al. (2020) quote 
one interviewee who explains: “I’ve been told for so many years that I 
don’t have an eating disorder, there’s nothing wrong with me, I’m being 
dramatic” (p. 83). Research indicates that clients of  color, particularly 
Black clients, are significantly less likely to be diagnosed with an eating 
disorder when displaying the same eating and exercise behaviors and 
thought patterns as their white counterparts and non-Black counterparts 
of  color (NEDA, 2018). Underdiagnosis may also be attributed to 
an over-attribution of  symptoms to gender dysphoria because “the 
conversation about bodies may be so focused on gender that important 
information is missed” (Chang et al., 2018, p. 115). Certainly the 
relationship between gender dysphoria and weight dysphoria or body 
dysmorphia is a nuanced one. 

RECONCILING CONTRAINDICATED INTERVENTIONS

This complex comorbidity of  gender dysphoria and body 
dysmorphia must be explored further. On the surface, the most common 
treatment approaches to each are in fact contraindicated. Chang et al. 
(2018) articulates the dangerous potential contradiction clearly:

A common message in society as well as in eating disorder 
treatment and recovery communities is ‘Just accept yourself  as 
you are.’ Although this may be an ideal or goal to strive toward 
regarding body size and weight acceptance, this message can be 
misapplied in a distorted and harmful way to trans people. It 
can suggest that trans people should just learn to accept and live 
in accordance with the gender identity associated with their sex 
assigned at birth. (p. 117)

This failure to affirm and validate gender identity in eating disorder 
treatment drives potential patients away from seeking care in the first 
place. Duffy et al. (2016) report on a study of  transgender people with a 
history of  eating disorder treatment, sharing that of  the 84 participants, 
“some even expressed wishing they had never gone to treatment at all, 
despite acknowledging that it was likely life saving” (p. 144). Gender-
competent care and empathy are critical if  providers hope to “heal” 
their patients from what patients may experience as bringing about 
affirming physical change and a sense of  control. Kosciewicz et al. 
(2020) emphasize that there is “psychic and physical pain involved in 
relinquishing the ED as the primary means for self-regulation” (p. 69). 

MEDICAL TRANSITION & GATEKEEPING

Further, acknowledgement and diagnosis of  an eating disorder for a 
trans patient may prevent access to gender-affirming medical treatments 
that could alleviate the need for “self-transitioning” behavior. Because 
trans individuals require clearance from a behavioral health provider 
to access surgeries, the existence of  any mental health diagnoses may 
halt the process--and, while WPATH Standards of  Care do currently 
clarify that “mental health conditions may be present” (if  “reasonably 
well managed”), “health-care providers may believe that a client should 
resolve eating-disordered behavior before they are appropriate for 
undergoing GCMIs” (Testa et al., 2017, p. 928). Such pitfalls would 
likely be ameliorated by adequate training of  medical professionals. At 
the moment, few training programs offer information that is specific to 
transgender populations (Duffy et al., 2016). Given this lack of  education, 

SULA MALINA



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experiences of  eating disorders specific to transgender populations are 
easily ignored. Popular treatment models for eating disorders often target 
behavioral changes with insufficient attention to their underlying causes, 
and can thus be harmful for the transgender populations they may seek 
to serve. In part, limited research on the subject of  transgender patients 
and eating disorders is to blame. Without an understanding of   how 
access to physical transition can impact mental health outcomes and 
level of  body satisfaction for transgender people, clinicians risk conflating 
client body dissatisfaction rooted in gender dysphoria with a negative self-
image that centers around size and/or weight. Nutritionists, dieticians, 
and doctors are limited in their ability to apply nutritional needs to 
transgender clients, due to a lack of  guidelines on the calculation of  such 
needs or ideal body weights for clients who are on hormones (Kosciewicz 
et al., 2020). 

INACCESSIBILITY OF CARE

Despite recent advancements in the clinical treatment of  eating 
disorders among transgender populations, effective, gender-affirming 
interventions remain largely inaccessible to the most marginalized trans 
individuals. Transgender people, and particularly transgender POC, are 
disproportionately impacted by poverty and homelessness, and thus face 
significant financial barriers in access to care (National LGBT Health 
Education Center, 2018). Despite recent policy advocacy, many insurance 
plans still exclude gender-affirming medical treatments from coverage 
(National LGBT Health Education Center, 2018). Even for those with 
access, limitations remain as to what changes existing treatments can 
facilitate. Although testosterone therapy facilitates body fat redistribution, 
it brings with it a wide variety of  other physical changes with which an 
individual may not identify (such as facial/body hair or a deeper voice). 
Though Witcomb et al. (2015) identify that “the body parts that were 
most reported to cause the most dissatisfaction were those associated with 
body shape” (p. 291), these may be the very adjustments most difficult to 
attain through current medical interventions, as they may be “relating to 
skeletal changes at puberty” that are irreversible (Witcomb et al., 2015, 

p. 288). Further limitations of  medical intervention are demonstrated 
by the psychological and emotional effects of  pubertal suppression on 
transgender pre-teens, as such intervention can leave them “looking 
younger than their peers,” causing distress (National LGBT Health 
Education Center, 2018, p.3). While such medical advancements may fall 
beyond the purview of  a social worker, clinicians must be informed on 
what their transgender clients may experience as deterrents to accessing 
medical interventions. 

PROMISING PRACTICES

For those working with a younger population in a clinical setting, 
early intervention is critical. The National LGBT Health Education 
Center recommends that treatment for eating disorders begin prior 
to adolescence when possible, in order to prevent long term health 
consequences (National LGBT Health Education Center, 2018). For 
those working with transgender clients of  any age who experience 
disordered eating, existing literature suggests a few promising practices: 
unsettling “diagnosis”; querying “acceptance”; holding space for 
mourning; and utilizing modalities and frameworks which acknowledge 
the impact of  discrimination-based stress, trauma, and attachment 
disruption on clients. Given the potential contraindication of  healing 
approaches to eating disorders and gender dysphoria, Chang et al. (2018) 
recommend that practitioners not designate some patients’ concerns 
as either diagnosis, “but rather as both or an interaction of  the two,” 
employing “the dialectic of  acceptance and change that is integral 
to mindfulness-based approaches such as ACT and DBT” (p. 117). 
Koscieweicz et al. (2020) open a critique of  the very notion of  mental 
health diagnosis. As they point out:

We can challenge the normative treatment model of  asking 
clients to learn to love their bodies by dismissing body 
dissatisfaction as a purely cognitive distortion. For all of  our 
clients (especially trans and GNC people of  color) the body 
exists within a social, political, and historical context that has 
been a place of  both power and violence. ( p. 79) 

SULA MALINA



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By rejecting the “medical model” of  mental health in favor of  a 
“social model,” practitioners can identify the sociopolitical forces culpable 
for both gender dysphoria and disordered eating. Acknowledgement of  
this reality requires that clinicians guide clients through the simultaneous 
processes of  mourning and behavioral shift. As Kosciewicz et al. (2020) 
write, “this tolerance for the uncertainty, the unknowability of  the 
outcome of  mourning, is crucial to the treatment of  clients who are 
reliant on disordered eating behaviors to defend against the body/psyche 
disjuncture” (p. 69). Utilization of  the minority stress framework is one 
component of  anti-oppressive practice, which emphasizes the very real 
implications of  socially constructed (but historically enacted) gender 
identity and cissexism. 

LIMITATIONS
Existing research on eating disorders among transgender populations 

is significantly lacking, and that which does exist centers almost entirely 
on the experiences and diagnoses of  white transgender youth. In order 
to begin to understand the impact of  interlocking systems of  oppression 
on transgender people of  color, disabled transgender people, and those 
with other compounding marginalized identities, researchers must 
dedicate energy to the intentional recruitment of  diverse respondents. 
Additionally, current research largely omits experiences of  transgender 
adults, greatly limiting opportunities for eating disorder professionals 
to develop best practices when working with those beyond adolescence. 
Though many sociopolitical factors driving EDs are consistent across 
age groups, transgender adults may be rendered further vulnerable to 
disordered eating behaviors if  these are driven by gender dysphoria and 
medical transition has already been “completed.” Indeed, much is left to 
learn regarding the treatment of  gender dysphoria for those who have 
seemingly reached the “limits” of  what physical transition (hormonal and 
surgical) can provide. 

CONCLUSION
This review of  existing literature reveals that people who are 

transgender are disproportionately impacted by disordered eating due 
to forces that extend far beyond the “purely psychological” (Koscieweicz 
et al., 2020). Social workers, who embrace an anti-oppressive, “social 
model” of  mental health, are uniquely positioned to advocate for and 
provide affirming, evidence-based interventions (Koscieweicz et al., 
2020). Such interventions reject negative body image related to gender 
dysphoria as “purely cognitive distortions” and ground treatment in 
the validation of  transgender clients’ lived experience with forces of  
oppression (Koscieweicz et al., 2020). In this sense, social workers have 
the opportunity not only to address the unique needs of  individual 
clients, but also to carry forward the work of  activists past and present 
committed to dismantling cissexism, racism, sexism, and other forces of  
oppression in society at large.

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SULA MALINA

SULA MALINA (they/them) is a Masters of  Science in Social 
Work candidate at Columbia School of  Social Work in Advanced 
Clinical Practice, concentrating in Health, Mental Health, and 
Disabilities. Sula holds a Bachelor of  Arts in Gender & Sexuality 
Studies from Bryn Mawr College. They work as a social work 
intern at The Gender & Sexuality Therapy Center in New  
York City. Originally from Cambridge, Massachusetts, Sula lives  
in Manhattan.


