Eating Disorders in Transgender, Non-Binary, and Gender Diverse Populations: A Meta-Synthesis of Qualitative Findings

Some evidence suggests that gender diverse people may be disproportionately affected by eating disorders in comparison to the general population. This review aims to further understanding of the relationship between gender identity and disordered eating/exercise, as understood by gender diverse individuals.

Qualitative papers were identified through systematic searches of key databases, using relevant search terms. Eligible studies were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist and analyzed using Thematic Synthesis.

In total, 18 studies were included in the review. Six superordinate themes were identified, exploring the interconnectedness of gender dysphoria and eating disorders; the use of disordered eating to modify the body to better align with gender identity and socially prescribed expectations of gender; disordered eating as a means of coping emotionally; and the roles of structural, societal, and interpersonal experiences of discrimination and marginalization. The impact of gender-affirming care on disordered eating, eating disorder treatment experiences, as well as recovery and protective factors; including the importance of understanding and connecting with gender identity, connection with others and wider communities, and resistant narratives were also explored.

The findings highlight the complex and multifaceted relationships between gender identity, gender dysphoria, and disordered eating. Several important clinical implications were identified, including the need to better address systemic inequalities and improve inclusivity of eating disorder services and clinical awareness of disordered eating presentations in gender diverse populations (within both gender and eating disorder services). Limitations and further research directions are further discussed.