Most research on eating disorders (EDs) among adolescents has primarily focused on cisgender individuals, who identify with the gender they were assigned at birth (Mensinger et al., 2020; Riddle et al., 2024). Limited research exists on non-binary and transgender or gender diverse (TGD) adolescents, leading to a gap in knowledge and tailored interventions for these groups. Traditional ED treatments may not fully address the unique experiences of TGD individuals, such as higher rates of comorbid mental health issues (Becerra-Culqui et al., 2018) and challenges with body positivity that may worsen gender dysphoria rather than improve body acceptance (Duffy et al., 2016; Hartman-Munick et al., 2021).
To address this gap, Riddle et al. (2024) conducted a study comparing ED symptom severity, depression, suicidality, and anxiety between cisgender and TGD adolescents undergoing higher levels of care (HLOC) ED treatment. The study aimed to assess the effectiveness of current treatment approaches developed in cisgender populations for TGD individuals.
The study recruited adolescents (<18 years) admitted to HLOC ED treatment centers in the US between August 2020 and June 2022. All participants met DSM-5 ED criteria through semi-structured interviews conducted by licensed mental health professionals. Outcomes measured included eating disorder symptoms (EDE-Q), depression severity and suicidality (PHQ-9), and anxiety symptoms (GAD-7) at admission and discharge. Results from the study showed significant improvements in ED symptoms, depression, suicidality, and anxiety following interventions for both cisgender and TGD adolescents. However, TGD individuals had higher levels of depression, suicidality, and anxiety both at admission and discharge compared to cisgender individuals. Sensitivity analyses confirmed the robustness of the findings. Strengths of the study included statistical rigor and enhanced internal validity through sensitivity analyses. However, limitations such as the absence of long-term follow-up, small sample size, and measurement validity issues were noted. Future research is needed to validate measures for TGD individuals and explore long-term treatment outcomes and differences among gender-diverse individuals. The study suggests similar efficacy of ED treatments for cisgender and TGD adolescents but highlights the need for adjunctive interventions to address TGD adolescents' unique challenges. Clinicians are encouraged to consider screening for elevated comorbidities and providing referrals to appropriate services post-discharge. Longitudinal studies and replication with larger, diverse samples are recommended to further understand treatment responses among different gender identities. Additionally, research on the intersectionality of cultural norms and gendered body ideals in ED treatment is warranted.
