Eating Disorders in Transgender and Gender Diverse Communities

A growing body of research highlights that transgender (trans) and gender diverse people face a heightened risk of eating disorders. Studies estimate that up to 23% of trans young people experience a current or past eating disorder, compared to a lifetime prevalence of 10.5% in the Australian general population. Recent data indicated that 18% of trans young people reported an eating disorder diagnosis, which is significantly higher than the 1.8% of cisgender young people reporting a current eating disorder (1.8% women and 0.2% men). While research in this area remains underdeveloped, the statistics highlight the need for trans-inclusive and gender affirming eating disorder treatment.

Factors which can contribute to Eating Disorders for Trans and Gender Diverse people

In addition to the commonly recognised environmental, genetic, and personality trait factors which can contribute to an eating disorder, trans and gender diverse individuals may face unique, additional factors.

Gender Dysphoria

Gender dysphoria refers to the significant distress that can arise when a person’s gender identity does not align with the sex they were assigned at birth. This distress can strongly influence how someone relates to their body, especially in the context of eating and appearance.

  • For some, eating disorder behaviours may be used as a way to modify their body—such as altering body composition, suppressing secondary sex characteristics, or delaying puberty—to feel more aligned with their gender identity

  • These behaviours may also serve as a coping strategy to numb or distract from emotional distress, or as a form of self-punishment linked to internalised stigma or shame

  • The pressure to 'pass' as a particular gender due to societal norms and expectations can increase body dissatisfaction, particularly when bodies do not conform to cisnormative standards

  • Gendered social norms have also influenced ideals of androgynous bodies, which like stereotypes of masculinity and femininity can be narrow, restrictive and limiting

These complex dynamics make it critical that eating disorder treatment is equipped to sensitively and competently address the emotional and physical aspects of gender dysphoria.

Transgender IdentitY and AFFIRMATION

Being transgender refers to identifying with a gender that is different from the sex assigned at birth. While being trans is not inherently linked to eating and body image concerns, the societal and internal challenges that many trans people face can contribute to risk for eating disorders. Navigating gender identity in a cisnormative world can create distress around the body, especially when it does not align with one’s gender. For some, eating disorder behaviours may be used to gain a sense of control, reduce the visibility of unwanted gendered features, or cope with stigma and exclusion.

Gender affirmation can include social transition (e.g. changing pronouns, name, clothing and appearance); legal transition (e.g. updating name and gender marker on legal documents such as birth certificate); and medical transition (e.g. hormone therapy, puberty blockers and gender affirming surgeries). It’s personal to each trans and gender diverse person which forms of affirmation they choose to engage with, and all choices are valid.

As one example, hormone therapy, such as oestrogen or testosterone, can be an important part of gender affirmation and may have a powerful impact on body image and eating concerns. For the majority, gender-affirming hormones help reduce dysphoria and promote a stronger sense of self, supporting more positive relationships with food and the body. It is important to be aware that the physical and emotional changes brought about by hormones can also be complex and emotionally charged, especially if expectations are unmet or if access to care is inconsistent or unsupported. These dynamics can influence how someone experiences their body, sometimes in ways that intersect with eating disorder thoughts or behaviours.

Lack of representation, affirmation, and understanding from health professionals can further compound these difficulties, highlighting the importance of inclusive and informed care.

Minority Stress

Minority stress refers to the unique and chronic stressors faced by people from marginalised communities, such as trans and gender diverse individuals. This includes experiences of discrimination, stigma, exclusion, and systemic inequity. These stressors can significantly impact mental health and are linked to an increased vulnerability to eating disorders.

  • Navigating systems that invalidate or marginalise gender identity can lead to persistent stress, which can in turn trigger or exacerbate eating disorder symptoms

  • Potentially concerning eating behaviours may emerge as a coping mechanism—offering a sense of control, emotional regulation, or escape from the distress of discrimination

  • Some people may engage in eating disorder behaviours as a form of self-protection, for example by modifying their body to 'pass' and avoid transphobic harm or to delay coming out in an unsafe environment

  • Limited access to safe and affirming gender-affirming care can increase distress and the risk of relying on coping behaviours to manage gender dysphoria

  • Internalised transphobia, resulting from ongoing exposure to societal rejection or marginalisation, can negatively impact self-worth, body image, and overall psychological wellbeing in all areas

Protective Factors

While the relationship between gender, body image, and eating behaviours can be complex, it's important to recognise that trans and gender diverse people can also be supported by meaningful protective factors. These can act as buffers against the development or progression of eating concerns and promote overall wellbeing.

  • Access to all forms of gender-affirming care (including social, legal and medical affirmation) is consistently associated with reduced risk and severity of eating disorder symptoms. Feeling more aligned with one’s gender can lessen distress and support a more positive relationship with the body

  • Strong social support and connection—whether from friends, family, or community—can improve mental health outcomes, reduce isolation, and create a sense of safety and belonging

  • Being part of affirming gender-diverse communities can help challenge harmful beauty standards and binary gender ideals. These spaces often foster acceptance, authenticity, and empowerment, allowing people to express themselves without pressure to conform

What is Trans and Gender Inclusive Eating Disorder Therapy?

Trans and gender inclusive eating disorder therapy recognises the unique experiences of trans and gender diverse people and ensures that care is affirming, respectful, and responsive to each individual’s gender identity. This includes using correct names and pronouns, addressing the impact of gender dysphoria and minority stress, supporting access to gender affirming care, and avoiding assumptions based on binary gender norms. Therapy may also explore the intersections between body image, identity, and eating behaviours in a safe, non-pathologising way. Inclusive treatment is grounded in collaboration, validation, and empowerment—supporting clients to explore their relationship with food, their bodies, and themselves without judgement.

At Mind Body Well, we are committed to providing safe and affirming healthcare for LGBTQIA+ communities. If you are seeking support, we recommend reaching out to see a Psychologist or Dietitian on our team, all of whom have experience in gender diversity and eating concerns. We also recommend the following support services:

  • QLife - provides free daily peer support from trained members of the LGBTIQA+ community Australia wide via anonymous phone and webchat

 

References

  • https://eatingdisorders.org.au/eating-disorders-a-z/eating-disorder-statistics-and-key-research/

  • McGregor, K. et al. (2023) ‘Disordered Eating and Considerations for the Transgender Community: a Review of the Literature and Clinical Guidance for Assessment and Treatment’. Journal of Eating Disorders, 11(75)

  • Cusack, Claire E. et al (2022) ‘“I’m Still Not Sure If the Eating Disorder Is a Result of Gender Dysphoria”: Trans and Nonbinary Individuals’ Descriptions of Their Eating and Body Concerns in Relation to Their Gender’. Psychology of sexual orientation and gender diversity, 9(4)

 

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Are you Actively or Passively Restricting your Food Intake?

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Periods of inadequate or irregular eating can occur for a multitude of reasons, including food restriction. A common feature across many eating disorders, food restriction involves limitation of the variety, adequacy or regularity of the foods that we eat. Food restriction may occur as a result of active and deliberate attempts to reduce dietary intake, or it can arise more subtly - due to a lack of conscious attention to meeting our nutritional needs.

Active Restriction

Active restriction involves conscious, intentional efforts to limit or control food intake, often driven by specific goals or fears related to weight, body shape, or food itself. Common examples of active restriction include:

  • Selective eating: Avoiding foods deemed ‘unhealthy’, often leading to rigid food rules and reduced variety of ‘safe’ food options

  • Weight loss dieting: Following prescribed plans with a goal to lose weight, which often involves tracking and limiting daily intake to stay within a set target (eg. calorie counting)

  • Fasting: Skipping meals or going extended periods without eating to reduce overall food intake

For people experiencing an eating disorder, active restriction is often associated with Anorexia Nervosa (significant and prolonged food limitation motivated by an intense desire to control body weight and shape). However it is important to recognise that active restriction is central to almost all eating disorders, including Bulimia Nervosa and Binge Eating Disorder, where restriction fuels reactive cycles of binge eating (and potential compensatory behaviours).

Passive Restriction

Passive restriction, on the other hand, occurs less intentionally. People who are restricting in a more passive way may not actively try to limit their food intake, but lack the drive to eat due to a variety of factors, such as:

  • Forgetting to eat: Skipping meals unintentionally, often due to preoccupation with work, life stress, or distraction with other activities

  • Lack of appetite: Reduced hunger cues, which may stem from psychological and emotional  factors such as low mood or heightened anxiety, or physical factors

  • Health Conditions: Chronic illnesses, digestive issues, or some medications can reduce appetite and cause people to go extended periods without food

  • Sensory sensitivities: Avoiding certain foods due to characteristics such as texture, taste, or smell, making it difficult to eat a balanced diet

While not always related to an eating disorder, passive restriction can be a characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID), particularly when caused by sensory sensitivity. Passive restriction can also be related to other eating disorders - for example, when someone unconsciously welcomes opportunities to ‘forget’ to eat, or downplays their nutritional needs.

Food Scarcity and Restriction

Food restriction can also be influenced by external factors such as food scarcity. Limited access to adequate nutrition due to financial constraints or unpredictable food availability can lead to involuntary restriction. This is important to understand as a separate factor to other forms of restriction, as it necessitates strategies to improve food access and the consistent availability of adequate nutrition.

Can Active and Passive Restriction Overlap?

Although these forms of restriction can seem distinct, they do often overlap. Someone who initially experiences passive restriction (such as skipping meals due to low appetite) might develop active restriction over time, given inadequate dietary intake can be a trigger for the development of an eating disorder.

Similarly, an eating disorder can disguise itself as passive restriction, making disordered behaviours harder to recognise. For example, someone experiencing an eating disorder might frequently say they’re “too busy to eat," when in fact this has become a way to justify restriction.

Addressing Restriction in Recovery

It’s important to be curious about and to understand what’s motivating restrictive eating behaviours, in order to then decide on the best course of treatment. Both Psychologists and Dietitians experienced in eating disorder therapy can assist with this, and Dietitians in particular can assist in recommending strategies to focus on more adequate nutritional intake.

Active restriction often requires addressing thoughts, fears, and beliefs about food and body image. Passive restriction may call for strategies to support appetite awareness, manage sensory sensitivities, or to build regular eating habits. Both types of restriction can benefit from therapeutic assessment, strategies and support to change, which our team at Mind Body Well are able to provide.

The Art of Active Listening: Transform Your Conversations

How active listening can transform your communication

Active listening is a powerful communication skill that enhances both personal relationships and professional interactions. Instead of the common habit of half-listening while formulating a response, active listening encourages us to fully engage with what is being said, leading to deeper understanding and stronger connections.

What is active listening?

Active listening means being fully present with the speaker and genuinely processing the information being communicated. Simply hearing someone does not equate to truly listening. Hearing is a passive process—our brain perceives sound without necessarily engaging with it. Listening, however, is an active process that requires attention, comprehension, and effort to truly understand what the speaker is trying to convey.

Why is active listening important in communication?

Active listening plays a crucial role in strengthening relationships and building trust. When we truly listen, we show empathy, respect, and appreciation for the other person’s perspective. This fosters mutual understanding and enhances relationships with partners, family members, friends, and colleagues.

In professional settings, active listening is essential for effective leadership, teamwork, and collaboration. Managers who actively listen to their employees create an environment where individuals feel heard and valued, leading to greater job satisfaction and productivity.

The key principles of active listening

To master active listening, consider these five key principles:

  1. Pay attention
    Give the speaker your undivided attention, free from distractions. Observe non-verbal cues like body language and facial expressions to fully grasp their message.

  2. Show that you’re listening
    Maintain eye contact, nod occasionally, and use encouraging cues like "yes" or "uh-huh" to demonstrate your engagement.

  3. Provide feedback
    Reflect on what the speaker has said by paraphrasing: "What I’m hearing is..." or "It sounds like you’re saying..." Asking clarifying questions can also help ensure you understand correctly.

  4. Defer judgment
    Resist the urge to jump to conclusions or interrupt. Give the speaker space to fully express their thoughts before forming your own response.

  5. Respond appropriately
    When it’s your turn to speak, be honest and respectful. Even if you disagree, responding thoughtfully fosters meaningful dialogue.

Barriers to active listening

Several factors can hinder active listening. Being aware of these barriers can help you overcome them:

  • Environmental distractions – Noise, technology, and physical obstacles that interfere with communication.

  • Stress – High stress levels can make it difficult to concentrate and absorb information.

  • Personal biases – Preconceived notions, cultural differences, and personal experiences can influence how we interpret what is being said.

How to practice active listening effectively

Like any skill, active listening requires practice and patience. Here are some strategies to help you develop it:

  • Be present – Remove distractions, put your phone down, and focus on the speaker.

  • Stay curious – Approach conversations with an open mind and ask follow-up questions.

  • Find common ground – Engaging in topics of mutual interest can help sustain meaningful dialogue.

Real-life examples of active listening in action

  1. Improving relationships
    A couple discusses a recent disagreement. One partner actively listens by setting aside distractions, making eye contact, and refraining from interrupting. They summarize what they heard before sharing their own perspective, fostering better understanding and compromise.

  2. Navigating workplace feedback
    An employee receives constructive criticism from their employer. Instead of reacting defensively, they actively listen, ask clarifying questions, and acknowledge the feedback. This leads to a productive discussion on improvement strategies and professional growth.

Active listening is a transformative skill that enhances both personal and professional relationships. By being fully present, demonstrating engagement, and responding thoughtfully, you can create deeper connections and improve communication in all aspects of life.