Why do so many transgender people have eating disorders?

While young women have long been the face of eating disorders, transgender people are now suffering from the illnesses at higher rates than cisgender straight women.

A new study published in the Journal of Adolescent Health looked at eating disorder rates among college students, and—in one of the first studies to do so—included transgender individuals in the participant group.

The study used data from the American College Health Association-National College Health Assessment survey, which included responses from 289,024 students enrolled in 223 U.S. universities. Of the respondents, 479 identified as transgender.

The survey asked about eating disorders in two ways. First, participants were asked if they had ever been treated or diagnosed with an eating disorder. Second, they were asked if they had vomited or taken laxatives within the past 30 days and whether they had used diet pills within the past 30 days. Other items measured were substance abuse, mental health, sexual behavior, and nutrition.

The results? Transgender people reported the highest rates of treatment and diagnosis of an eating disorder as well as the use of laxatives, vomiting, and diet pills. More so even than cisgender heterosexual women (the next highest group). Cisgender heterosexual males were the least likely to suffer from eating disorders.

The question is: Why are transgender people at greater risk than the general population? The researchers offered several key reasons behind the rise.

To suppress or accentuate gendered features

The researchers hypothesize that one reason transgender individuals may be more prone to eating disorders is because of their desire to alter their body.

“It has been suggested that striving for weight loss may be a way for transgender women to conform to feminine ideals of slimness and attractiveness,” they write. “Transgender men and women may also use weight loss to suppress secondary sexual characteristics.”

For example, anorexia nervosa can lead to extreme weight loss and, in turn, decrease breast size and natural curves—which a transgender man (born female) may wish to accomplish.

Stress

Another reason for the rise? Transgender individuals may experience greater “minority stress” than other groups, which the researchers define as “the excess stress experienced by individuals in stigmatized social categories.”

As Alexis Duncan, assistant professor of the Brown School and School of Medicine at Washington University in Saint Louis and author on the study, told Fusion in an email, “Transgender people experience particularly high levels of stress due to things like discrimination, bullying, and violent victimization”—and past research has shown a strong link between stress and poorer mental health outcomes, which can include eating disorders.

The researchers add that transgender individuals who were unsure of their sexual orientation were also more likely to report eating disorders than other groups. “It may be that individuals who are unsure of their sexual orientation are less able to access social minority communities as a source of social support, which appears to ameliorate minority stress,” the authors write.

Previous contact with mental health professionals

More transgender individuals reported being professionally treated for an eating disorder than other groups, and the researchers believe this could be because transgender individuals already have more contact with mental health professionals to begin with.

“Transgender individuals are often required to attend counseling to receive gender affirming treatments, increasing their overall rate of interaction with mental health professionals,” they write. Noting, a previous study found that 75 percent of transgender participants had received counseling on their gender identity.

However, since transgender individuals were also the most likely to report non-treated disordered eating behaviors (laxatives, vomiting, diet pills), the access to counseling is only a small piece of the puzzle.

The takeaway?

At its core, the study highlighted the risk transgender individuals face when it comes to disordered eating, which may have previously been overlooked. Which means the medical community needs to take note.

“More nuanced examinations of these topics are necessary for the development of targeted eating disorder intervention and prevention efforts for the gender and social minority community,” write the researchers. “Clinicians should also be aware that transgender clients may be at increased risk for eating-related pathology and should adjust screening practices accordingly.”

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.