Disordered eating in autistic trans and gender diverse people: a lived experience-led scoping review

This lived experience-led scoping review explores the evidence base related to eating disorders/disordered eating behaviours in Autistic trans and gender diverse (TGD) people. This review highlights the currently available data on eating disorder prevalence rates, comparisons with allistic and cisgender groups, drivers and maintenance factors, the relationship between eating disorders and gender-affirming medical care, and treatment outcomes in this population.

We conducted a search of the databases ProQuest, Medline, CINAHL, Cochrane Library, Web of Science, Scopus, and PsycINFO for articles relating to eating disorders/disordered eating behaviours in Autistic TGD people. Five articles published between 2021 and 2025 met the criteria for the review.

The included articles were predominantly cross-sectional studies (n = 4) and one case series (n = 1). Researchers used a mixture of self-reported and clinically recorded eating disorder diagnoses, as well as validated measures, including the Eating Disorder Examination Questionnaire and the Nine-Item Avoidant/Restrictive Food Intake Disorder Scale. The literature highlights that the prevalence of eating disorders/disordered eating behaviours is high in the Autistic TGD population, and suggests that atypical presentations may be particularly common. Possible drivers and maintenance factors include sensory hypersensitivity, co-occurring Attention-Deficit Hyperactivity Disorder, gender dysphoria and passing concerns, and appearance pressures idealising thinness. Limited data were available on the role of gender-affirming medical care or eating disorder treatments, or on treatment outcomes.

Further research is needed to better understand the nuances of eating disorders/disordered eating behaviours in Autistic TGD people. Key to future research inquiries should be the adoption of an intersectional approach, co-production of research with Autistic TGD people, and research considering treatment outcomes.