“My body image issues and my focus on my imperfections will never go away. They are so ingrained into my physique that it’s just a part of me now.” – Ryan Sallans.
Ryan Sallans has been a vocal advocate for awareness around eating disorders in the trans community, sharing vulnerable anecdotes from experiences he carries with him years into recovery. His writing and public speaking on eating disorders draws attention to just how prevalent they are among trans people, with 15% of transgender college students experiencing eating disorders, almost four times the rate of eating disorders among non-trans peers.
Despite being some of the most deadly mental health conditions, second to opiate overdose, eating disorders are largely misunderstood, especially within the trans community. Many of us are familiar with common myths about eating disorders, for example, that eating disorders only affect women and young people, or that all people with eating disorders are underweight. In reality, people of any gender, age, or body type can be impacted by eating disorders.
Trans people are particularly vulnerable to developing an eating disorder. Controlling food is sometimes used as a tool to control body shape and appearance: 32% of transgender people report using their eating disorder to modify their body without hormones. Losing or gaining weight may help to cope with gender dysphoria.
This was certainly true for me when I started to count calories before starting testosterone. I felt that losing weight was a way for me to control my appearance, giving me a more masculine body shape and helping me cope with gender dysphoria. Ryan Sallans shared about how his eating disorder helped alleviate his dysphoria in college:
“I did find comfort in the fact that the way I ate (or didn’t eat) brought me a more masculine figure. I didn’t have hips or breasts. I stopped menstruating, so I didn’t have a traumatic monthly reminder that I could carry a child.”
Given how common it is for transgender people to be survivors of sexual violence, it’s important to discuss the connection between eating disorders and survivorship. A blog post from NSVRC describes how controlling food and dieting can serve as a coping mechanism after experiencing sexual violence:
“Many victims and survivors describe feeling a lack of control in the aftermath of their experience of abuse. Controlling behaviors around food and exercise may suppress difficult emotions and provide a temporary sense of control. In these ways and many others, an eating disorder creates distance from painful, uncomfortable feelings and seeks to numb or avoid them.”
Sometimes, eating disorders may have little to do with a desire for a particular body shape, but rather a desire for control in circumstances when someone feels out of control. Disordered eating behaviors might be used to control big emotions, gender dysphoria, or other environmental stressors.
Trans and nonbinary people also face barriers when seeking care for eating disorders:
“The trans community, in the past, has been invisible when it comes to treatment and care around eating disorder awareness and programming” (Ryan Sallans)
There is a lack of research and knowledge specific to trans experiences with eating disorders. Finding a trans-affirming healthcare provider is a challenge alone, and compounding this effect, many trans people experience discrimination, trauma, or violence when seeking treatment.
Despite the high prevalence of eating disorders among trans people, it’s not something I often hear talked about. Even among young non-transgender women, eating disorders are often relegated to invisibility because of shame and stigma.
When you don’t “look like” someone who might conventionally have an eating disorder, whether because of your perceived gender, body type, or age, it’s even more difficult to be open about experiences with eating disorders. For example, men often do not get treatment for eating disorders because of the perception that eating disorders only impact women, and that excessive exercise and dieting are normal facets of “fitness culture.” People in larger bodies and Black, indigenous, and people of color are half as likely as others to be diagnosed with an eating disorder, despite having similar prevalence rates.
Even after years of being relatively free from restrictive eating habits, the weight of shame associated with eating disorders and trans identity have often been too heavy to share with others. During my freshman year of college, I was hanging out with a group of female friends late at night in one of the campus common spaces. We had all gotten to know each other fairly well after spending a week backpacking together, and relying on each other to navigate the new territory of college life back on campus. I had not initially shared that I was trans with this group of people, and had mixed feelings about broaching the topic. That night, my friends started talking about their experiences with body image and disordered eating. I sat there quietly, reflecting on those difficult years when even walking to school, with the wind blowing my shirt up against my body, was painful. I wanted so badly to share in the intimacy of this conversation, but the barriers of being a masculine-appearing person, someone you might not expect to have an eating disorder, held me back.
Over the past couple of years, I learned that my sister was also struggling with an eating disorder. I also learned that it was fairly common for multiple people in the same family to have an eating disorder. Despite being geographically far away from each other, this brought up old memories from my own history. I had never shared with my sister my own struggles with an eating disorder during my teens.
When I flew back to Wisconsin to visit for the holidays, the two of us went for a walk, trying not to slip on the ice on a cold winter day. We talked about how we had both been struggling for a long time before being able to open up to anyone, and how isolating it is to be alone with self-destructive thoughts and emotions. I wondered how different things would have been if I had been able to talk openly about my own experiences. While it may not have changed how things went for either of us, it may have alleviated some of the pain of feeling alone in our struggles.
This is why it’s important to me to bring awareness to trans experiences with eating disorders this week. Conversations like these open up an opportunity for people to feel seen and understood in their struggles. Even though there have been many moments when I did not feel like I could be open about my own story, I hope that continuing to have more open conversations about eating disorders in the trans community will lead others to feel seen and understood, even if they aren’t able to share their own story in that moment either. The awareness that others have faced a similar struggle helps us to feel less alone.