Violence Isn't the Only Threat to Transgender Youth

The transgender community embodies resilience. Just this month, Danica Roem became the first openly transgender state legislator, winning her seat in the Virginia House of Delegates from long-serving Bob Marshall, a man who refused to debate her or use her preferred pronouns during the campaign. It's milestones like Roem's election, that we celebrate during Transgender Awareness Week, while looking ahead to continued progress.

As the fight against transphobic legislation continues to play out very publicly, we mustn't overlook issues that may present more as private struggles or those that are frequently fought in silence. A prime example is the disproportionate impact of eating disorders on transgender youth. For the many who may not know, eating disorders have the highest mortality rate of any mental illness.

In my role as the community education and outreach coordinator for The Center for Eating Disorders at Sheppard Pratt, I see firsthand that eating disorders do not discriminate. If you were to walk into any of our treatment centers or support groups you would see extremely diverse groups of people, often very different than the young, white, cisgender protagonists that dominate media representations of eating disorders. Despite persistent stereotypes, it's important to talk openly about the fact that eating disorders actually affect people of any age, weight, gender, sexual orientation, socioeconomic status and religion.

Eating disorders are complex issues with complex contributing factors. While genetic risks play a big role, other influencing factors include body dissatisfaction, low self-esteem, trauma, interpersonal conflict, depression and anxiety, dieting behaviors and coping skill deficits. Individual experiences with an eating disorder can vary greatly but our patients -- both cis and trans -- commonly identify negative body image as contributing to their deep struggles with food and weight. The connection with one's body can be strained even more when body dissatisfaction intersects with gender dysphoria.

For trans folk, those risk factors can be further exacerbated by daily discrimination and violence experienced as a result of stigma, bullying, and oppression. This trauma, is thought to contribute to increased risks for eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder and other specified and unspecified feeding and eating disorders.

The scientific literature confirms this health inequity among transgender youth. Data collected across 223 U.S. colleges and universities, published in 2015, found that transgender youth are four times as likely to report having an eating disorder and twice as likely to report abuse of diet pills and purging behaviors compared to cisgender heterosexual women.

A 2016 study also concluded transgender youth are at increased risk for disordered eating. Compared with cisgender males, transgender youth had higher odds of fasting, using diet pills, taking laxatives and higher odds of lifetime use of steroids.

It's time we sound the alarm, but not without a note of caution and understanding. A 2017 case report reflecting on the simultaneous presence of gender dysphoria and eating disorders put it best: "It is essential, both from an ethical and a clinical point of view, that the notion of 'comorbidity' be properly understood, in order to avoid the risk that a helpful finding is turned into an additional stigma for transgender people and an obstacle to provision of medical treatment."

One thing is clear -- whether you are an individual seeking recovery for yourself, or trying to help a family member or a friend -- support is essential to well-being. Knowledge that our nation's transgender youth experience a higher prevalence of eating disorders is half the battle. From here, we can proactively offset these risks by speaking out and promoting support. An online health survey that pooled responses from transgender youth across Canada found that family connectedness, inclusivity at school, and caring friends served as protective factors for transgender youth against developing disordered eating behaviors.

This #TransWeek and year-round, let's continue to advocate for trans-inclusive policies at local, state, and federal levels. Let's champion body acceptance and inclusivity online, in our schools and in our neighborhoods. Most importantly, let's make sure we all know the signs of an eating disorder because early and effective treatment can make a huge difference. If you're concerned that someone you love may be facing these challenges, reach out and show support. This is one battle that does not need to be fought alone.

KATE CLEMMER is the community outreach coordinator at The Center for Eating Disorders at Sheppard Pratt.