Transgenderexia: One and the Same?

This past August President Paul Monagle of the conservative lobby group known as The Australian Family Association sent an e-mail to its members advising them to tell family and friends that being transgender “is the same as having an eating disorder,” particularly anorexia nervosa. He cites social worker Moira Fleming’s op-ed piece, written for the right-wing U.S. website The Federalist, by saying the following:

“Fleming says that both anorexia or transgendering [sic] are driven by a mismatch between the person’s brain and their body, ‘a wrenching awareness of what it feels like to be disconnected from your body, to hate with every fiber of your being the way you look in the mirror.’”

Through her work, Fleming reveals her experience of self-loathing while battling anorexia, but she makes a stretched argument to show how providing a transgender individual with medical treatment and allowing them to transition is the same as allowing someone with anorexia to starve themselves (Fleming, 2016). Being transgender and having anorexia — are they truly both one and the same?
The only way to find the answer to this question is to define being transgender and having anorexia. On one hand, transgender is an umbrella term that signals movement between or across genders, and a transgender person is someone who identifies as a gender other than the one they were assigned to at birth based on the appearance of their sex organs (Hartke, 2016). Sometimes transgender individuals will experience gender dysphoria, a sense of anxiety or distress over the difference between their physical body and their gender identity (“Gender Dysphoria,” 2013).

Because of the psychological distress associated with gender mismatch, some people such as Monagle and Fleming argue that being transgender is similar to having anorexia or bulimia. To clarify any confusion, eating disorders (namely anorexia and bulimia nervosa) are often associated with body dysmorphic disorder (BDD), a disorder in which an individual perceives their body in a way that does not align with reality (Hartke, 2016). According to the DSM-V guidelines, the word dysmorphia itself means malformation, and refers to the person’s perception that their body is somehow malformed; for example, someone with dysmorphia may find a part or parts of their body to be overweight, which can impose them to develop a disordered relationship with food.

Michelle Telfer, Australia’s leading pediatrician on transgender issues, says that “the distress that one experiences over gender dysphoria is considered something that needs treatment,” and she distinguishes the fact that anorexia is a mental illness while being transgender is not (Rae, 2016). What Telfer wants people to know is that gender dysphoria is a symptom of distress associated with being transgender, where being transgender is an identity and not to be approached as a symptom or disorder that needs to be treated.

Though gender dysphoria and body dysmorphic disorder are different in nature, an individual can suffer from both at the same time. A 2015 study of students at 223 different universities revealed that transgender individuals were more than four times as likely to report an eating disorder diagnosis as cisgender individuals, particularly heterosexual women (Strandjord et al. 2015). From these reports, transgender women state that they experience the same cultural pressures to stay thin as do cisgender women, and transgender men strive to maintain a low body weight to repress female secondary characteristics such as breasts and menstruation (Strandjord et al. 2015).

Unfortunately large-scale research of eating disorders in transgender individuals is limited, and a wide knowledge gap exists; for instance, a majority of reported cases focus on male-to-female (MTF) individuals, while reports on female-to-male (FTM) individuals are rarer and typically describe adults who have lived with known gender dysphoria for years (Fernandez-Aranda et al 2000; Hepp & Milos 2002). On a more positive note, mental health professionals with previous experience treating LGBT individuals often treat these communities in a more holistic manner by not only incorporating therapy and medication into the individual’s physical transition but also aiding in the restoration and management of weight (Ewan et al. 2014). Even still, many transgender individuals who have not been able to transition have expressed that disordered eating and excessive exercise seem to be their only options to achieve more masculine or feminine qualities.

As a society, we need to realize that being transgender and having an eating disorder may entail similar characteristics and can sometimes overlap, but they are not one and the same. First, being transgender is an identity, whereas having an eating disorder is a mental illness. Second, body dysmorphia can cause someone to believe their body is a certain way, while gender dysphoria is a sense that the body should be a different way. Finally, we need to be more accepting of others who find themselves along the spectrum and non-conformant to the binary labels of male/female and man/woman because they can eventually have a better transition without having to feel distressed by the outward appearance that they do not find representative of themselves.

References

American Psychiatric Association. (2015). Body Dysmorphic Disorder. Retrieved from http://dx.doi.org/10.1176/appi.focus.130205

American Psychiatric Association. (2013). Gender Dysphoria. Retrieved from http://dx.doi.org/10.1176/appi.books.9781585625048.gg39

Ewan, L. A., Middleman, A. B., & Feldmann, J. (2014). Treatment of Anorexia Nervosa in the Context of Transsexuality: A Case Report. International Journal of Eating Disorders, (47): 112–115. doi:

Fernandez-Aranda, F., Peri, J. M., Navarro, V., Badia-Casanovas, A., Turoacuten-Gil, V., & Vallejo-Ruiloba, J. (2000). Transsexuialism and Anorexia Nervosa: A Case Report. Eating Disorders, (8):63–66. doi:10.1080/10640260008251212.

Fleming, Moira. “Why is Transgender an Identity But Anorexia a Disorder?” The Federalist, 27 Jun 2016. Retrieved from http://thefederalist.com/2016/06/27/why-is-transgender-an-identity-but-anorexia-a-disorder/

Hartke, Austen. “Is Being Transgender A Mental Disorder?” Queer Grace, 2016. Retrieved from http://queergrace.com/transgender-and-mental-illness/

Hepp U, Milos G. Gender identity disorder and eating disorders. Int J Eat Disord 2002; 32:473–478. doi:10.1002/eat.10090.

Rae, Bobby. “Being ‘Transgender is Like Anorexia’ Claim Conservative Lobby Group.” Pink News, 19 Aug 2016. Retrieved from http://www.pinknews.co.uk/2016/08/19/being-transgender-is-like-anorexia-claim-conservative-lobby-group/

Strandjord, S. E., Ng, H., & Rome, E. S. (2015). Effects of Treating Gender Dysphoria and Anorexia Nervosa in a Transgender Adolescent: Lessons Learned. International Journal Of Eating Disorders, 48(7), 942–945. doi:10.1002/eat.22438.