Review by Michael Spaulding-Barclay
Jones, B. A., Haycraft, E., Bouman, W. P., Brewin, N., Claes, L., & Arcelus, J. (2017). European Eating Disorders Review, 26(2), 120-128.
In cis-gendered individuals, body dissatisfaction is necessary but insufficient for the development of an eating disorder. Perfectionism, interpersonal problems, low self-esteem, and anxiety and depression are also associated with the development of eating disorder psychopathology. Compared to the general population, transgendered individuals have increased rates of body dissatisfaction primarily due to gender incongruence, yet also have increased levels of anxiety, depression, perfectionism, low self -esteem, and interpersonal problems. For transgendered adults, medical transition (cross-sex hormone treatment (CHT) or surgery) has been shown to improve body dissatisfaction and, in one small study, surgery was shown to improve eating disorder psychopathology in transgender women.
This was a large(n=563) cross-sectional study of adult (17+ years), mixed transgender male and female subjects in the UK. It examined the reasons why CHT improves body dissatisfaction and identified mediators of change in eating disorder psychopathology. The study found that transgendered men and women not receiving CHT (compared to those who were receiving CHT) had higher body dissatisfaction and eating disorder psychopathology. Furthermore, they found that anxiety, self-esteem, and perfectionism acted as mediators of the link between body dissatisfaction and eating disorder psychopathology. Thus, CHT helps reduce eating disorder psychopathology not only through improvement in body dissatisfaction, but also directly through improvements in anxiety, self-esteem, and perfectionism.
Why is this Important?
Implications for practice include the need for eating disorder providers to recognize that transgender patients may present with eating disorder psychopathology and body dissatisfaction prior to acknowledging their gender incongruence. Because CHT has been shown to improve body dissatisfaction and is more effective in decreasing eating disorder psychopathology in transgender patients than standard eating disorder treatment, screening for gender incongruence in eating disorder settings has the potential to identify those who would benefit more directly from CHT. Furthermore, since very high levels of body dissatisfaction before CHT has been associated with continued high levels of body dissatisfaction after CHT (and therefore risk for eating disorder psychopathology), so too must the transgender health provider recognize that continued body dissatisfaction after CHT may be an indicator of risk for eating disorder psychopathology that would benefit from coordinated eating disorder care.