Eating disorder screening and treatment experiences in transgender and gender diverse young adults

Transgender and gender diverse (TGD) young adults have elevated risk for disordered eating, unhealthy weight control behaviors, and eating disorders (EDs). Little is known about TGD young adult experiences with ED screening and treatment; this qualitative study aimed to address this gap. This study used data from eight asynchronous online focus groups, a dynamic online bulletin board method (N = 66). Participants posted responses to moderator-posed questions over a 4-day period. Participants were TGD young adults ages 18-30 years old, were recruited using social media and outreach to community organizations, and resided in 25 US states. We conducted inductive thematic analysis of all focus group excerpts that described experiences with ED screening or treatment (n = 32). Participants were of diverse gender identities (25% transgender woman, 41% transgender man, 28% non-binary, 6% another gender) and racial/ethnic identities (62% White, 13% Latinx, 13% Multiracial, 6% Asian, 6% Black). Three major themes emerged from the analysis: (1) Barriers to ED screening/treatment; (2) Complexity of the relationship between EDs and gender dysphoria; (3) Need for provider education in gender affirming care practices for ED screening and treatment. Results indicate an ongoing need for gender affirming care for TGD young adults in ED screening and treatment. Health care systems must address barriers to screening and treatment for TGD young adults, including enhancing understanding of the intersection of gender dysphoria and eating disorders as well as improvements in health care provider training.