Today marks the beginning of National Eating Disorder Awareness Week. In the past, we’ve shared statistics about the prevalence of eating disorders in trans communities and perspectives from trans authors on eating disorders. This year, we want to acknowledge the overlap between eating disorders in trans communities and the rising wave of anti-trans legislation that negatively impacts trans and nonbinary peoples’ mental health, while also targeting our access to healthcare.
We already know that mental health issues, including eating disorders, are prevalent among trans communities. But what happens when state-sanctioned hate exacerbates existing mental health challenges or complicates someone’s recovery from an eating disorder?
For some, political and cultural turmoil surrounding transgender rights has had a direct effect on wellbeing and eating disorder recovery. In 2017, one trans man shared:
“The climate surrounding politics these days has taken a toll on my mental health and with it, made it more difficult to continue in recovery. As pretty much any trans person will tell you, transphobic bills and rhetoric are nothing new in the political sphere or anywhere else. That being said, we’ve reached a new level lately with an increase in bills debating what bathrooms we can use and rescinding the few protections we had at school and work, and the all-time-high number of transgender individuals murdered so far in 2017 (mostly trans women of color). In this political moment, being visibly trans can feel more exhausting than in the past.” (Lucas Knudsen, 2017)
Since 2017, anti-trans legislative efforts have only gotten more forceful, and with them, an influx of anti-trans vitriol in popular culture. When these debates, “conversations,” and outright attacks on trans rights are happening in public places, social media, and popular media platforms, it’s often hard to avoid coming face-to-face with the realities of anti-trans hate in our daily lives.
This constant exposure to hate takes a toll. For trans and nonbinary people who have eating disorders, body image issues, gender dysphoria, low self-esteem, and internalized hatred may flare up in ways that challenge our ability to persevere through eating disorder recovery.
“Almost every day, it seems like we’re bombarded with a new law or article attacking our basic humanity for the crime of daring to live as a trans person. Listening to folks debate whether or not you are allowed to participate in social institutions that most take for granted can be an incredibly dehumanizing experience and there can be a lot of anger and/or pain that comes with that. For better or for worse, one coping mechanism when dealing with these negative emotions is to return to patterns of disordered eating. More recently, acknowledging how these feelings (oftentimes on top of any gender-related dysphoria I may be feeling that day) may be contributing to an uptick in eating disorder behaviors has helped me continue along the road to recovery more smoothly.” (Lucas Knudsen, 2017)
For many trans and nonbinary people who are unable to access gender-affirming care, whether based on age, legal restrictions, financial limitations, parental support, etc., controlling food and eating may feel like a way to regain control that we don’t otherwise have.
“In the UK, gender affirming treatments are inaccessible until age 18, and it often takes more time than this due to extremely long waiting lists for trans-specific clinics. For me, this led to feelings of being out of control that manifested as an eating disorder.” (Charlie, 2023)
“I developed bulimia when I was a teenager as a way to slow down puberty since I was denied medical care.” (Woman with a trans history, 2022)
Restrictions on gender-affirming care may be a deterrent for trans and nonbinary people to disclose their experiences with eating disorders (particularly legislation that restricts access to care on the basis of not having mental health conditions like anxiety or depression). Even though some of these bills have been struck down, the fear remains that disclosing mental health concerns might limit someone’s access to gender-affirming care.
When having to go through a medical gatekeeper, like getting a letter from a therapist that says someone is “stable enough” to start hormones, it might feel necessary not to disclose having an eating disorder to avoid being denied care. While many trans people find that gender-affirming care improves their relationship to their body, and helps to treat their eating disorder, the fear of being denied care is very real, and in some states, legal. One trans woman shared:
“The worst days of my eating disorder coincided with the only period of my life I’ve been in counselling. As part of my transition I required a diagnosis to receive the medical treatment I desired to be who I am. A big part of these sessions was determining whether I was “stable” enough to begin hormone replacement therapy. I was 19 and had been dealing with my trans identity for a few years at that point so I kept the fact I was suffering with bulimia to myself. I feared being stowed away in the “unstable” box and not receiving the support I needed for my trans identity.” (Toryn)
This is an example of how state-sanctioned hate directly contributes to trans and nonbinary people not having access to the care they need: mental and physical healthcare that can accommodate both their needs for gender-affirming care and eating disorder treatment.
When anti-trans violence is more prevalent than ever, many trans people may worry that not having a gender-conforming appearance puts them at risk for physical attacks based on their perceived gender identity. This in turn can lead to people being more restrictive with their eating in order to maintain a more gender-conforming appearance.
“I’m a trans woman, which means I feel pressure to uphold conventional femininity for my bodily safety. Not being read as a woman exposes me to a wide spectrum of discriminatory violence. At best, I could see foul looks from people and at worst, it could end violently for me. I live with persistent anxiety over whether bad social interactions are because somebody saw me as transgender, or if they went badly for other reasons. This elevated level of presentation management is so tiresome.” (Summer, 2023)
We also know that when trans and nonbinary people seek out treatment for eating disorders, many treatment facilities are not trans-inclusive or welcoming. Mental and physical healthcare providers may also turn trans people away as a result of being emboldened by anti-trans legislation:
“…there’s a piece of legislation in this state it’s called the Conscience Clause. So, essentially, it gives people (providers) a pass (on religious or conscience grounds)…we’ve had clients that said, ‘this person seemed okay or they were the only one that took my insurance, I had appointments,’ and then the person is telling him, ‘I need to refer you out because I don’t have enough experience to treat you.’ They’re back in the same place of, ‘I’ve been vulnerable (disclosed gender ID) and that person told me, I can’t help you.’” (Eating disorder specialist, 2023)
This document provides an overview of the wide-ranging and destructive impacts of “Religious Exemptions” in healthcare, although it was published in 2018, so the data on state legislation does not reflect today’s reality.
All of this paints a devastating picture for trans and nonbinary people who are struggling with eating disorders, many in silence and without support. But it doesn’t have to be this way. When trans people have access to the mental and physical healthcare we need, including gender-affirming care and eating disorder treatment, we can escape the grasp of disordered eating.
Several trans and nonbinary folks have shared hopeful messages about eating disorder recovery that I hope can be heartening in the face of these legislative and cultural challenges:
“I also have rediscovered the importance of finding support systems that support your whole being (i.e. not just a trans person or an individual in recovery but a trans person in recovery). Find providers or therapists who can both validate your identity and also acknowledge how it may affect your coping mechanisms or recovery plan. The voice of disordered eating often wants to tell us that for some reason we are different, that even though everyone else deserves to be successful in recovery, we alone do not deserve to be healthy or stay healthy. That nasty little voice is only amplified when you have groups in power advocating that you don’t even deserve basic rights, let alone to successfully live in recovery from an eating disorder.” (Lucas Knudsen, 2017)
“The more comfy I get in my gender, the farther away my ED gets.” (Gender queer/fluid person, 2022)
“My gender transition flowed with eating disorder recovery. Recovery wouldn’t have been possible without transition, and I can’t see myself as a happy woman if I still fought my body’s basic needs every day. It’s heartwarming to see that all of this persistence and learning just brought me to… myself.” (Summer, 2023)
“To all of my trans siblings, just know you’re not alone. Eating disorders and trans identities are both portrayed as being “fads” by the media. So to be a trans person with an eating disorder can feel like a little much. You are complex and beautiful, and you deserve support in every part of your life. Get support. Look after yourself. You are more than enough.” (Toryn)