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Chakkour E, Simone M, Askew AJ, Blashill AJ. The association between gender-affirming care and disordered eating in transgender and gender diverse individuals: Exploring appearance congruence and gender-related motivating factors for weight loss. Int J Eat Disord 2024; 57:1576-1588. [PMID: 38549493 PMCID: PMC11262982 DOI: 10.1002/eat.24202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/21/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The objective of this study is to explore between-group differences across different stages of gender-affirming care, and associations between appearance congruence, gender-related motivations for weight loss, and disordered eating in transgender and gender expansive (TGE) individuals. METHOD A total of 160 TGE adults (aged 18-30) were recruited across the United States. Participants completed a comprehensive online survey. Data were analyzed using generalized linear models and bivariate correlations. RESULTS Significant differences in appearance congruence among participants at different transition stages were revealed, with the group that achieved their desired transition reporting the highest appearance congruence compared to all other groups. Furthermore, gender-related motivations for weight loss were significantly lower in individuals who achieved their desired transition compared to those with no plans to transition. DISCUSSION Findings suggest significantly higher appearance congruence in those who achieved their desired transition compared to other groups, and individuals who attained their desired transition exhibited significantly reduced gender-related motivations for weight loss compared to those with no plans to transition. These findings underscore the potential psychological benefits associated with successful gender-affirming care, highlighting its role not only in fostering appearance congruence but also in mitigating gender-related motivations for weight loss among TGE individuals. Future research should include larger and more diverse samples, longitudinal designs, and considerations of other factors influencing body image outcomes in this population. PUBLIC SIGNIFICANCE This study sheds light on the crucial relationship between gender-affirming care and body image outcomes in TGE individuals. Understanding how appearance congruence and gender-related motivations for weight loss are associated with disordered eating can inform tailored support and interventions. By recognizing the association of gender affirming care and well-being, healthcare providers can enhance care for TGE individuals.
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Affiliation(s)
- Em Chakkour
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - Melissa Simone
- Department of Psychology, University of Colorado Denver, 1200 Larimer Street, Denver, CO, 80217, United States
| | - Autumn J. Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Aaron J. Blashill
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, United States
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
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Linsenmeyer W, Stiles D, Garwood S, Giedinghagen A, Lewis C, Strand G. The Sick, Control, One Stone, Fat, Food (SCOFF) is a Valid Eating Disorder Questionnaire to Use With Transgender Youth. Clin Pediatr (Phila) 2024; 63:971-976. [PMID: 37712557 DOI: 10.1177/00099228231200754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Transgender youth experience elevated rates of eating disorders, yet few screening measures have been validated with transgender patients. The purpose of this study was to provide initial evidence for the internal consistency and convergent validity of the Sick, Control, One Stone, Fat, Food (SCOFF) in a sample of transgender youth. Two hundred eight participants completed the SCOFF as part of a routine screening protocol. Exploratory factor analysis and confirmatory factor analysis were used to establish the factor structure of the SCOFF in this sample. Relationships between the SCOFF, Adolescent Binge Eating Disorder (ADO-BED), Nine-Item Avoidant/Restrictive Intake Disorder (NIAS), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and demographic characteristics were explored. The SCOFF was significantly related to all convergent validity variables, with moderate correlations with other eating disorder scales (ADO-BED and NIAS). The SCOFF is a valid measure to screen for eating disorders among transgender youth and young adults.
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Affiliation(s)
| | | | - Sarah Garwood
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Christopher Lewis
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Gretta Strand
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Nagata JM, Stuart E, Hur JO, Panchal S, Low P, Chaphekar AV, Ganson KT, Lavender JM. Eating Disorders in Sexual and Gender Minority Adolescents. Curr Psychiatry Rep 2024; 26:340-350. [PMID: 38829456 PMCID: PMC11211184 DOI: 10.1007/s11920-024-01508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE OF REVIEW To consolidate recent literature addressing eating disorders and disordered eating behaviors among sexual and gender minority (SGM) adolescents, including but not limited to lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents. RECENT FINDINGS Sexual and gender minority adolescents are at heightened vulnerability to eating disorders and disordered eating behaviors compared to their cisgender and heterosexual peers, potentially due to minority stress, gender norms, objectification, and the influence of the media, peers, and parents. We report findings from recent literature on the epidemiology and prevalence, assessment, mental health comorbidity, quality of life and psychosocial functioning, risk and protective factors, and treatment and interventions for eating disorders in sexual and gender minority adolescents. Addressing eating disorders in sexual and gender minority adolescents requires an integrated approach consisting of screening, tailored treatment, and comprehensive support to address intersectional challenges. Gender-affirming and trauma-informed care approaches may be considered.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, 94143, CA, USA.
| | - Elena Stuart
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, 94143, CA, USA
| | - Jacqueline O Hur
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, 94143, CA, USA
| | - Smriti Panchal
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, 94143, CA, USA
| | - Patrick Low
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, 94143, CA, USA
| | - Anita V Chaphekar
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, 94143, CA, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
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Riddle M, Blalock DV, Robertson L, Duffy A, Le Grange D, Mehler PS, Rienecke RD, Joiner T. Comparing eating disorder treatment outcomes of transgender and gender diverse adolescents with those of cisgender adolescents. Int J Eat Disord 2024; 57:1555-1565. [PMID: 38483005 DOI: 10.1002/eat.24195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/11/2024] [Accepted: 03/01/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Eating disorder (ED), depression, and anxiety symptoms at admission and discharge were compared, as were admission-to-discharge changes, for transgender and gender diverse (TGD), and cisgender adolescents receiving intensive treatment for EDs. METHOD Participants were 44 TGD and 573 cisgender adolescents admitted to a treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) at admission and discharge. RESULTS Both groups had elevated EDE-Q scores at admission (TGD: M = 3.78, standard deviation [SD] = 1.70; cisgender: M = 3.33, SD = 1.74) that improved by discharge (TGD: M = 2.27, SD = 1.83, Cohen's d = .98; cisgender: M = 2.10, SD = 1.54, Cohen's d = .79); there were no differences in EDE-Q between groups at admission (p = .09; odds ratio [OR] = 1.18, 95% confidence interval [CI] [.98, 1.44]) or discharge (p = .48; OR = 1.07, 95% CI [.88, 1.30]). On admission, TGD adolescents had higher suicidality, measured by PHQ-9, item 9 (p < .001; OR = 1.94, 95% CI [1.51, 2.52]), and depression (p < .001; OR = 1.10, 95% CI [1.05, 1.16]) than cisgender participants. Severity decreased over treatment for all measures. Both groups showed similar improvement on suicidality (p = .93; OR = .98, 95% CI [.70,1.36]), depression (p = .42; OR = 1.02, 95% CI [.97, 1.07]), and anxiety (p = .14; OR = 1.05, 95% CI [.99, 1.12]). However, at discharge, suicidality (p = .02; OR = 1.40, 95% CI [1.04, 1.85]), depression (p < .01; OR = 1.06, 95% CI [1.02, 1.11]), and anxiety (p = .02; OR = 1.06, 95% CI [1.01, 1.12]) were higher for TGD adolescents than their cisgender peers. DISCUSSION All participants had similar ED symptom severity and improvement. Depression, anxiety, and suicidality remained elevated for TGD adolescents compared to their cisgender peers at discharge, suggesting the need for targeted treatment. PUBLIC SIGNIFICANCE Transgender and gender diverse (TGD) adolescents have increased risk of eating disorders (EDs); few studies examine how they respond to ED treatment. We examine treatment outcomes of TGD adolescents receiving ED treatment compared to their cisgender peers. We measured ED symptoms along with depression, anxiety, and suicidality at the beginning and end of treatment. While TGD adolescents showed similar improvement in ED symptoms, measures of depression, anxiety, and suicidality remained elevated at the time of discharge.
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Affiliation(s)
- Megan Riddle
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Bellevue, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- Emeritus, Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
- ACUTE at Denver Health, Denver, Colorado, USA
- Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Usta Sağlam NG, Zengin K, Osmanlı Shirolu S, Sulu C, Kırpınar MM, Turan Ş. Disordered eating behaviors in gender-affirmative treatment seeking transgender people. Eat Disord 2024:1-16. [PMID: 38557398 DOI: 10.1080/10640266.2024.2336277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study aimed to explore disordered eating behaviors in gender-affirming treatment (GAT)-seeking transgender (TG) adults and cisgender people, in addition to analyzing the association between gender dysphoria intensity, body mass index, and disordered eating behaviors. Data were collected from 132 GAT-seeking TG people with gender dysphoria who had never received GAT (91 TG men, 41 TG women), and 153 cisgender (99 cisgender men, 54 cisgender women) participants from Turkey. The Utrecht Gender Dysphoria Scale was used to evaluate the intensity of gender dysphoria. Eating Disorder Examination Questionnaire and Questionnaire on Eating and Weight Patterns-5 were utilized to assess disordered eating. There was no difference between TG women and TG men in terms of ED psychopathology. The most prominent characteristic in all four groups was shape concern, which was significantly higher in TG men and TG women when compared to cisgender men and cisgender women. Binge eating was notably more frequent in TG men and TG women compared to cisgender men, with 11% of the TG men and 7.3% of the TG women meeting the criteria for possible binge eating disorder. Screening for disordered eating behaviors, particularly binge eating, may be recommended in routine care for TG people.
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Affiliation(s)
- Nazife Gamze Usta Sağlam
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Kerem Zengin
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Sadiga Osmanlı Shirolu
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Cem Sulu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Mehmet Murat Kırpınar
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Şenol Turan
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
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Askew AJ, Randall A, Alvarez JC, Elbe CI, Caravelli N, Gonzales M, van der Star A, Blashill AJ. Examining the association of structural stigmas with body image-related outcomes among sexual minority individuals. Body Image 2024; 48:101652. [PMID: 38141492 DOI: 10.1016/j.bodyim.2023.101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
Sexual minority individuals display heightened body image disturbance, which is associated with negative health outcomes. Structural stigmas are associated with negative health outcomes among sexual minority individuals, but the association between structural stigmas and body image is not understood. Using a linear regression approach, we examined how U.S. state-level structural racism and structural sexual minority stigma were associated with body image-related outcomes including eating pathology, appearance and/or performance-enhancing drug (APED) misuse, and dysmorphic concern. Participants were 942 cisgender sexual minority individuals ages 18-30, with approximately equal representation among non-Hispanic/Latinx White, Black, Asian, and Hispanic/Latinx individuals. There was not a significant main effect of state-level structural sexual minority stigma on body image-related outcomes. In states with higher structural racism, Hispanic/Latinx participants endorsed higher APED misuse, and this interaction was not significant among non-Hispanic/Latinx White individuals. This pattern was not found among Black or Asian participants, nor was it replicated for dysmorphic concern or eating pathology. Findings suggest that reducing exposure to structural racism could reduce APED misuse among Hispanic/Latinx individuals.
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Affiliation(s)
- Autumn J Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Alyson Randall
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Jordan C Alvarez
- Department of Psychology, Auburn University, Auburn AL, United States
| | - Connor I Elbe
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Nicolas Caravelli
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Manuel Gonzales
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Arjan van der Star
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States.
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Lightner JS, Schneider J, Grimes A, Wigginton M, Curran L, Gleason T, Prochnow T. Physical activity among transgender individuals: A systematic review of quantitative and qualitative studies. PLoS One 2024; 19:e0297571. [PMID: 38416705 PMCID: PMC10901310 DOI: 10.1371/journal.pone.0297571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024] Open
Abstract
Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.
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Affiliation(s)
- Joseph S. Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
| | - Justin Schneider
- Department of Nursing, California State University-San Bernardino, Palm Desert, California, United States of America
| | - Amanda Grimes
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
| | - Melissa Wigginton
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
| | - Laurel Curran
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Tori Gleason
- University of Kansas Medical Centers, Kansas City, Kansas, United States of America
| | - Tyler Prochnow
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, United States of America
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Hansson E, Schmidt M. "Good food equals good health": a focus group study of adolescent boys' perceptions of eating and weight. BMC Public Health 2024; 24:258. [PMID: 38254027 PMCID: PMC10804744 DOI: 10.1186/s12889-024-17740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Disordered eating refers to unhealthy, sometimes excessive eating including so-called compensatory behaviours such as extreme dieting or voluntary vomiting. Between 24% and 30% of adolescent boys are suggested to engage in disordered eating, making it a significant public health issue. However, current instruments for assessing disordered eating among adolescents have been primarily developed and validated for girls and women, which may make for flawed assessment of boys. The aim of this study is to shed light on adolescent boys' perceptions of eating, weight, and food intake to better understand their perspectives in service of disordered eating research. METHODS This exploratory study was conducted from May to November 2022 using focus groups with a total of 39 adolescent boys (aged 12-19 years) who attended 7th to 12th grade in one of four schools in Southern Sweden. In addition, participants completed a form with questions on background demographics and eating habits. The transcripts of the focus group discussions were analysed using thematic analysis. RESULTS The quantitative data showed that around one third of the adolescent boys were overweight or obese. They ate at least one meal per day with the family and ate healthy food about five days per week and unhealthy food about three. Analysis of the qualitative data yielded six themes: The intertwined relationship between food and one's health, "Don't worry, food makes you happy," "To be hungry or not. That is the question," Boys DO care about appearances, Dieting and weight gain, and Disordered eating is a tricky matter. CONCLUSION Adolescent boys appeared to have a good understanding of food and healthy eating. They also experienced body positivity and seemed to have only minor issues regarding their weight. The primarily pathological perspective used to measure disordered eating among girls seems in need of revision to adhere to boys' thoughts and ideas regarding eating and weight.
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Affiliation(s)
- Erika Hansson
- Faculty of Education, Kristianstad University, Kristianstad, Sweden.
| | - Manuela Schmidt
- Department of Quality Improvement and Leadership, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Campbell L, Viswanadhan K, Lois B, Dundas M. Emerging Evidence: A Systematic Literature Review of Disordered Eating Among Transgender and Nonbinary Youth. J Adolesc Health 2024; 74:18-27. [PMID: 37791928 DOI: 10.1016/j.jadohealth.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE This systematic literature review explores the evidence base related to the diagnosis and clinical management of eating disorders among transgender and gender nonbinary (TGNB) youth. Through an exploration of the literature, this review highlights key considerations for providers working with this population, including the complex relationship between body image and gender, the assessment of subthreshold eating disorder symptoms, the impact of gender-affirming care on eating disorder treatment outcomes, and available evidence-based metrics, with attention to factors impacting treatment, including family support, psychiatric comorbidities, and community safety. METHODS We conducted a search of the databases PubMed and Ovid MEDLINE for articles pertaining to eating disorders and TGNB youth, with forward citation chaining conducted via Google Scholar to provide a review of recent publications. Twenty-six articles published from 2017 to 2022 met the criteria for full-text review. RESULTS The selected articles primarily explored data from the United States and varied widely in methodology, including a systematic literature review (n = 1), narrative literature reviews (n = 3), case series (n = 4), case studies (n = 2), cross-sectional population surveys (n = 7), cross-sectional patient surveys (n = 3), other cross-sectional studies (n = 3), retrospective chart reviews (n = 2), and a retrospective longitudinal cohort study (n = 1). Most commonly, researchers sampled patients within the setting of gender clinics. Researchers used a range of validated measures in clinical settings, with the Eating Disorder Examination Questionnaire most frequently reported. The literature highlights several considerations unique to transgender populations, including the complex relationship between gender dysphoria, body dissatisfaction, disordered eating behavior, and gender-affirming care. DISCUSSION In clinical settings with TGNB youth, providers may consider implementing validated screening measures to assess for eating disorders. Future research should emphasize a nuanced understanding of the heterogeneity among TGNB patient populations and the impact of gender identity on treatment of eating disorders.
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Affiliation(s)
- Laura Campbell
- Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York.
| | - Katya Viswanadhan
- Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York
| | - Becky Lois
- Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York
| | - Melissa Dundas
- Division of Adolescent Medicine, Department of Pediatrics, NYU Langone Health, New York, New York
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Gordon AR, Beccia AL, Egan N, Lipson SK. Intersecting gender identity and racial/ethnic inequities in eating disorder risk factors, symptoms, and diagnosis among U.S. college students: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. Int J Eat Disord 2024; 57:146-161. [PMID: 37933620 PMCID: PMC10842502 DOI: 10.1002/eat.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population-level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities. METHODS Data from the Healthy Minds Study 2015-2019 (N = 251,310 U.S. university students) were used in a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate stratum-specific predicted prevalence estimates for self-reported thin-ideal internalization, ED symptoms, and ED diagnosis. The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the strata. RESULTS There was considerable heterogeneity in the predicted prevalence of our ED outcomes across the strata (e.g., .3%-18.3% for ED diagnoses). There were large disparities in all three outcomes, with transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. Moderation by race/ethnicity was also apparent, such that racial/ethnic disparities were wider within the cisgender groups relative to the transgender groups. VPCs indicated that ~10% of the total variance in ED outcomes was due to intersectionality between gender and race/ethnicity, over and above variance due to individual-level differences. CONCLUSION Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop preventive interventions centering health equity. PUBLIC SIGNIFICANCE Despite evidence that sexism, racism, and cissexism (i.e., anti-transgender prejudice) can impact EDs risk, little research examines the social patterning of EDs at the intersection of diverse gender and racial/ethnic identities. Using data from a sample of 250,000 U.S. university students, this study found that gender and racial/ethnic disparities in eating disorder risk are interrelated, highlighting the need to develop health equity centered preventive interventions.
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Affiliation(s)
- Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ariel L. Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Natalie Egan
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Sarah K. Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA USA
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Kramer R, Aarnio-Peterson CM, Conard LA, Lenz KR, Matthews A. Eating disorder symptoms among transgender and gender diverse youth. Clin Child Psychol Psychiatry 2024; 29:30-44. [PMID: 37343277 PMCID: PMC10748461 DOI: 10.1177/13591045231184917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Compared to cisgender peers, transgender and gender diverse (TGD) youth and adults report elevated eating disorder (ED) symptoms likely related to gender dysphoria and attempts to modify their bodies accordingly. Less is known about the impact on gender-affirming care and ED symptoms. This study aimed to expand on extant research and describe ED symptoms in TGD youth seeking gender-affirming care while exploring potential associations between gender-affirming hormone use and ED symptoms. A total of 251 TGD youth completed the Eating Disorders Examination-Questionnaire (EDE-Q) as part of routine clinical care. ANCOVAs and negative binomial regressions examined differences in ED symptoms among transgender females (identifying as female but assigned male at birth) and transgender males (identifying as male but assigned female at birth). ED severity was not significantly different among transgender females versus transgender males, (p = .09), or associated with gender-affirming hormone use (p = .07). Transgender females receiving gender-affirming hormones reported a greater proportion of objective binge eating episodes compared to those who were not (p = .03). Over a quarter of TGD youth reported engagement in ED behaviors suggesting assessment and intervention related to ED behaviors among TGD youth is imperative since adolescence is a particularly vulnerable period for adolescents and engagement in ED behaviors could lead to full ED development and medical risk.
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Affiliation(s)
- Rachel Kramer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Claire M Aarnio-Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Lee Ann Conard
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Katrina R Lenz
- Department of Child and Adolescent Psychiatry & Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail Matthews
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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12
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Yesildemir O, Akbulut G. Gender-Affirming Nutrition: An Overview of Eating Disorders in the Transgender Population. Curr Nutr Rep 2023; 12:877-892. [PMID: 37864747 DOI: 10.1007/s13668-023-00504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Transgender individuals are vulnerable to many nutrition-related conditions, especially eating disorders due to gender dysphoria. This review aims to summarize the current literature on eating disorders in transgender individuals. The issues that should be considered in nutrition care for the transgender population are discussed regarding public health. RECENT FINDINGS Transgender individuals can exhibit disordered eating behaviors to overcome the stress they experience due to stigma, discrimination, social exclusion, and abuse. Recent studies showed that disordered eating and clinical eating disorders are more prevalent among transgender than cisgender people. It is very important for a multidisciplinary team working in the clinic to understand the epidemiology, etiology, diagnostic criteria, and treatment of eating disorders in the transgender population. However, multidisciplinary nutritional care is limited due to the lack of transgender-specific nutrition guidelines. It is safe to say that adhering to a generally healthy nutritional pattern and using standardized nutrition guidelines. We recommend that health professionals working with patients/clients with eating disorders receive continuing education in transgender health, be empowering and inclusive, address patients/clients with their gender identity nouns and pronouns, and develop nutritional treatment plans that are not gender-specific. Eating disorders are a significant public health problem in the transgender population. Therefore, clinical screening and early intervention are necessary to identify and treat eating disorders in transgender people. Eating disorders in the transgender population should be monitored routinely, and gender-affirming care should be provided as well as treatment of eating disorders.
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Affiliation(s)
- Ozge Yesildemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bursa Uludag University, Bursa, 16059, Turkey.
| | - Gamze Akbulut
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Kent University, Istanbul, 34433, Turkey
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13
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Ogle JP, Johnson AN, Reddy-Best KL, Harmon J, Morris K, Kittersong P. A qualitative exploration of positive body image experiences among nonbinary individuals. Body Image 2023; 47:101632. [PMID: 37774425 DOI: 10.1016/j.bodyim.2023.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
One group whose positive body image experiences remain under-explored is individuals who identify as nonbinary, gender fluid, and/or genderqueer (including other nonbinary identities). Thus, we sought to answer the questions: What does it look like to have a positive body image for a nonbinary person? and How do nonbinary persons form and maintain a positive body image? To answer these questions, we conducted in-depth, semi-structured interviews with 15 nonbinary individuals who were assessed as having positive body image using the Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015a). Data were analyzed using reflexive thematic analysis. Four themes were identified as characterizing the core features of positive body image among nonbinary persons: body appreciation, body- and self-acceptance, bodily appearance embodied their authentic self, and holding flexible ideals for ways of being. Six themes were identified as related to on-going processes that explain how body image is formed and maintained among nonbinary persons: reframing negative body image information, staging resistance, experiencing representation, receiving and giving social support, practicing self-compassion and self-care, and using dress to create a satisfying presentation of self. In keeping with the tenets of queer theory, findings reflected how gender identity set a context for participants' positive body image experiences.
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Affiliation(s)
- Jennifer Paff Ogle
- Colorado State University, Department of Design & Merchandising, Mail Delivery Code 1574, Fort Collins, CO 80523-1574, USA.
| | - Ashlie N Johnson
- Linfield University, Department of Psychology, Pioneer Hall, Portland, OR 97230, USA
| | - Kelly L Reddy-Best
- Iowa State University, Department of Apparel, Events, and Hospitality Management, 31 McKay Hall, Ames, IA 50011-1178, USA
| | - Jennifer Harmon
- University of Wyoming, Department of Family and Consumer Sciences, AGC 3010, Laramie, WY 82071, USA
| | - Kristen Morris
- Colorado State University, Department of Design & Merchandising, Mail Delivery Code 1574, Fort Collins, CO 80523-1574, USA
| | - Piper Kittersong
- Colorado State University, Department of Design & Merchandising, Mail Delivery Code 1574, Fort Collins, CO 80523-1574, USA
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14
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Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Curr Opin Psychiatry 2023; 36:412-418. [PMID: 37781981 DOI: 10.1097/yco.0000000000000902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW This review summarizes recent research on eating disorders among gender minorities, transgender and gender diverse people. The focus is on research published in 2022 and the first half of 2023. RECENT FINDINGS Up to 1.2% of young people and 0.3-0.5% of adults identify as transgender, and 2.7-8.4% of young people and 0.3-4.5% of adults report some degree of gender diversity. About 20-50% of transgender and gender diverse people report engaging in disordered eating and >30% screen positive for eating disorder symptoms, and 2-12% have received an eating disorder diagnosis from a health professional. Many transgender and gender diverse people describe eating disorder symptoms as a way of coping with gender dysphoria. They also report high levels of mental and behavioral symptoms, particularly mood and anxiety disorders, suicidal thoughts and behaviors, trauma-related symptoms and disorders, alcohol and substance use, and autism. Gender minorities frequently experience discrimination, victimization, and violence, primarily sexual and physical violence. The minority stress model attributes mental health symptoms to these factors. Promising interventions based on the minority stress model have recently become available, but more research is needed on how to support transgender and gender diverse people with eating disorders. To manage eating disorders in this population, gender-affirming care should be combined with specialist eating disorder treatment. SUMMARY Gender minorities are at high risk for eating disorders. Future studies should assess what is the most appropriate treatment for transgender and gender diverse people with eating disorders.
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15
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Goodrich E, Walcott Q, Dallman J, Crow H, Templeton K. Bone Health in the Transgender Population. JBJS Rev 2023; 11:01874474-202310000-00013. [PMID: 37883596 DOI: 10.2106/jbjs.rvw.23.00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
» Transgender women are more susceptible to low bone mineral density (BMD) before initiating gender-affirming hormone therapy (GAHT), and while bone density initially improves with GAHT, it gradually declines while still remaining above baseline. Transgender women older than 50 years have a comparable fracture risk as age-matched cisgender women. Transgender men typically have normal or increased BMD before initiating and while receiving GAHT and are not at increased risk of fractures.» Transgender youth who receive puberty-blocking medications experience either no change or a slight decrease in BMD that returns to baseline after initiating GAHT.» It is important to abide by the International Society for Clinical Densitometry guidelines whenever ordering, performing, or reading a BMD scan for a gender-diverse patient.» There are no specific guidelines concerning vitamin D and calcium supplementation or the use of bisphosphonates in the transgender population, so the current recommendation is to abide by the guidelines for cisgender individuals.
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Affiliation(s)
| | | | | | - Hanna Crow
- Ascension Saint Thomas, Nashville, Tennessee
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16
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Nagata JM, Compte EJ, McGuire FH, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Lunn MR, Obedin-Maliver J. Investigating the factor structure and measurement invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a community sample of gender minority adults from the United States. Int J Eat Disord 2023; 56:1570-1580. [PMID: 37163420 PMCID: PMC10524485 DOI: 10.1002/eat.23978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults. METHODS Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported. DISCUSSION Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges. PUBLIC SIGNIFICANCE STATEMENT Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Emilio J. Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, México
| | - F. Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Tiffany A. Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA
| | - Matthew R. Capriotti
- Department of Psychology, San José State University, San Jose, CA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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17
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Heiden-Rootes K, Linsenmeyer W, Levine S, Oliveras M, Joseph M. A scoping review of the research literature on eating and body image for transgender and nonbinary adults. J Eat Disord 2023; 11:111. [PMID: 37400915 PMCID: PMC10318796 DOI: 10.1186/s40337-023-00828-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Eating disorder treatment approaches and outcome studies have historically centered almost exclusively on cisgender populations. Transgender and nonbinary (TGNB) adults are underrepresented in general and intervention research despite being at increased risk for eating and body image-related problems. AIMS This scoping review was designed to gather and examine the research with TGNB adults who experience eating and body image related problems, as well as clinical studies on the effectiveness of treatment approaches. METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used for reporting this review. MEDLINE and PsychInfo were used as electronic databases for searching subject terms. Inclusion criteria for studies required the quantitative measurement or qualitative exploration of body image or eating for TGNB adults. The relevant data were extracted and summarized based on quantitative findings and qualitative themes. RESULTS After review of over 1258 articles, 59 studies met criteria and data were extracted and summarized. Factors associated with eating disorders and body image problems across studies suggests gender-affirming medical interventions are effective and emphasized treatment for an eating disorder is warranted alongside gender affirming medical care. Body image was associated with eating patterns aimed at meeting gendered ideals of body shape and size. There was variation in guiding theories and absence of consensus in the definition of transgender in the review studies. This likely demonstrates the changing language, social acceptance of TGNB people and identities, diagnostic criteria, and clinical conceptualizations of eating and body image. CONCLUSIONS Future research should consider the use of theory for guiding inclusion of salient social factors influencing eating patterns, body image, and treatment outcomes. In addition, future research is needed that centers on nonbinary and genderqueer populations, as well as those from minoritized racial and ethnic groups to inform culturally appropriate concerns, needs, and treatment modalities.
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Affiliation(s)
- Katie Heiden-Rootes
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, 3700 Lindell Blvd., Ste 1100, St. Louis, MO, 63108, USA.
| | - Whitney Linsenmeyer
- Department of Nutrition and Dietetics, College of Health Sciences, Saint Louis University, St. Louis, MO, USA
| | - Samantha Levine
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, 3700 Lindell Blvd., Ste 1100, St. Louis, MO, 63108, USA
| | - Mark Oliveras
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, 3700 Lindell Blvd., Ste 1100, St. Louis, MO, 63108, USA
| | - Miriam Joseph
- University Libraries, Saint Louis University, St. Louis, MO, USA
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18
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Kalash N, Harb H, Zeeni N, El Khoury M, Mattar L. Determinants of body image disturbance and disordered eating behaviors among self-identified LGBTQ individuals. J Eat Disord 2023; 11:87. [PMID: 37268956 DOI: 10.1186/s40337-023-00810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/15/2023] [Indexed: 06/04/2023] Open
Abstract
It has been previously established that sexual minorities are more likely to suffer from mental health illnesses due to experiencing unique stressors such as fear, anxiety, stigma, harassment, and prejudice. Results revealed two noteworthy mental health disorders reported by lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, disordered eating behaviors and disturbed body image. Yet, a-priori studies revealed inconsistent results with regards to body image concerns and eating disorder symptoms and attitudes among sexual minorities. Therefore, this cross-sectional study aimed at investigating the occurrence of disordered eating behaviors (DEB) and body image disturbance (BID) among sexual minorities in Lebanon. Additionally, the correlation between several determinants of DEB and BID including fear of negative evaluation, generalized anxiety, social support, and harassment levels have been examined. Generally, the present study revealed that LGBTQ population scored higher than cisgender and heterosexual individuals for the mean and global scores of the EDE-Q6.0 and BAS-2. Only generalized anxiety and fear of negative evaluation scales were significantly associated with DEB and BID among different sexual orientation and gender identity individuals. Therefore, it is very important that health professionals working with such vulnerable populations meticulously assess for disordered eating behaviors and body image disturbance for better communication and management.
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Affiliation(s)
- Nour Kalash
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut, 1102 2801, Lebanon
| | - Hana Harb
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut, 1102 2801, Lebanon
| | - Nadine Zeeni
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut, 1102 2801, Lebanon
| | - Myriam El Khoury
- Psychology Program, Department of Social Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Lama Mattar
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut, 1102 2801, Lebanon.
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19
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Rasmussen SM, Dalgaard MK, Roloff M, Pinholt M, Skrubbeltrang C, Clausen L, Kjaersdam Telléus G. Eating disorder symptomatology among transgender individuals: a systematic review and meta-analysis. J Eat Disord 2023; 11:84. [PMID: 37237320 DOI: 10.1186/s40337-023-00806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to synthesize the literature on eating disorders and eating disorder symptomatology among transgender individuals and to summarize the existing literature on gender-affirming treatment and the prevalence of eating disorder symptomatology. METHOD The literature search for this systematic review and meta-analysis was performed in PubMed, Embase.com, and Ovid APA PsycInfo. We searched for "eating disorders" and "transgender" using both controlled vocabularies and natural language terms for their synonyms. The PRISMA statement guidelines were followed. Quantitative data from studies on transgender individuals and eating disorders assessed with relevant assessment tools was included. RESULTS Twenty-four studies were included for the qualitative synthesis, and 14 studies were included in the meta-analysis. The results revealed higher levels of eating disorder symptomatology among transgender individuals compared with cisgender individuals, especially cisgender men. Transgender men tend to display higher levels of eating disorder symptomatology than transgender women; however, transgender women seem to have higher levels of eating disorder symptomatology than cisgender men and, interestingly, this study also noted a trend toward transgender men having higher levels of eating disorders than cisgender women. Gender-affirming treatment seems to alleviate the presence of eating disorder symptomatology in transgender individuals. DISCUSSION The body of research on this subject is extremely limited, and transgender individuals are underrepresented in the eating disorder literature. More research investigating eating disorders and eating disorder symptomatology in transgender individuals and the relationship between gender-affirming treatment and eating disorder symptomatology is needed.
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Affiliation(s)
- Sofie M Rasmussen
- Psychiatry, Unit for Psychiatric Research, Aalborg University Hospital, Molleparkvej 10, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Martin K Dalgaard
- Psychiatry, Unit for Psychiatric Research, Aalborg University Hospital, Molleparkvej 10, 9000, Aalborg, Denmark
| | - Mia Roloff
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | - Mette Pinholt
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | | | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Gry Kjaersdam Telléus
- Psychiatry, Unit for Psychiatric Research, Aalborg University Hospital, Molleparkvej 10, 9000, Aalborg, Denmark
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
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20
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McGregor K, McKenna JL, Barrera EP, Williams CR, Hartman-Munick SM, Guss CE. Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment. J Eat Disord 2023; 11:75. [PMID: 37189185 DOI: 10.1186/s40337-023-00793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND It has been well established that individuals who identify as lesbian, gay, bisexual, transgender, and queer are at increased risk for mental health pathology, including eating disorders/disordered eating behaviors (ED/DEB). However, less is understood about the unique experiences of transgender and gender diverse (TGD) people who struggle with ED/DEB. AIMS The purpose of this literature review is to examine the literature regarding the unique risk factors for TGD individuals who experience ED/DEB through a lens informed by the minority stress model. Additionally, guidance around the assessment and clinical management of eating disorders for TGD individuals will be presented. RESULTS TGD people are at increased risk for developing ED/DEB due to a number of factors including: gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care. CONCLUSION While guidance around assessment and treatment of ED/DEB for TGD individuals is still limited, adhering to a gender affirmative care model is essential.
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Affiliation(s)
- Kerry McGregor
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - John L McKenna
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ellis P Barrera
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
| | - Coleen R Williams
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sydney M Hartman-Munick
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- UMass Memorial Children's Medical Center/UMass Chan Medical School, Worcester, MA, USA
| | - Carly E Guss
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Division of Pediatrics, Harvard Medical School, Boston, MA, USA
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21
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Hallward L, Nagata JM, Rodgers RF, Ganson KT. Examination of eating disorder psychopathology across sexual and gender identities among a Canadian sample. Int J Eat Disord 2023; 56:604-615. [PMID: 36493406 DOI: 10.1002/eat.23872] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Eating disorders (EDs) disproportionately affect sexual and gender minorities, with majority of research conducted among samples in the United States. The purpose of this study was to examine ED psychopathology among adolescents and young adults in Canada with diverse gender and sexual identities. METHOD Data were collected from 2,714 Canadians, aged 16-30 years old, via an online survey at the end of 2021 during the COVID-19 pandemic. Participants responded to sociodemographic questions (including history of EDs) and reported on eating attitudes and behaviors. Descriptive statistics and multiple modified Poisson and linear regressions were conducted. RESULTS Over half the sample was heterosexual, 35% were sexual minority cisgender men and women, and 6.5% were transgender and gender non-conforming (TGNC) people. The sample overall reported elevated ED psychopathology based on their eating attitudes and behaviors. TGNC participants reported the most severe ED psychopathology. Generally, sexual minority cisgender women and cisgender men had elevated ED psychopathology compared to their heterosexual counterparts. Regression analyses revealed all gender and sexual minorities reported greater ED psychopathology compared to heterosexual cisgender men. DISCUSSION The Canadian sample reported elevated ED psychopathology compared to previous studies among various populations. Additional investigations are now needed to observe how ED psychopathology continues to change after the onset of the pandemic. Further research is needed among cisgender men, TGNC people, and sexual minorities to understand the unique stressors they face that lead to high ED psychopathology, and develop appropriate prevention and treatment tools. PUBLIC SIGNIFICANCE EDs affect people of all gender and sexual identities. People who identify as a gender and/or sexual minority often experience problematic eating attitudes and behaviors, particularly transgender and gender non-conforming people of all sexual identities. More research attention is needed among these populations, especially due to a paucity of research among Canadians, to develop effective diagnostic tools, prevention efforts, and treatment programs specific to gender and sexual identities.
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Affiliation(s)
- Laura Hallward
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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22
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Ciao AC, Duvall A, Pascual S, Lawley KA. Expert peer facilitation of the EVERYbody Project: A randomized-controlled evaluation of a diversity-focused, dissonance-based, universal body image program for college students. Int J Eat Disord 2023; 56:372-383. [PMID: 36380601 DOI: 10.1002/eat.23852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A novel peer facilitation model was used to deliver a two session, dissonance-based, inclusive body image intervention that critically examines how internalized size-based oppression intersects with race, class, gender, sexuality, and ability. METHOD The EVERYbody Project was open to all college students and delivered by "expert" peer facilitators with body image and diversity experience and advanced facilitation skills. Recruitment was halted due to COVID-19; 90 students in the Northwest US (M age = 19.83 years, SD = 2.38; 80% female-identified, 13% male-identified, 7% gender expansive) were randomized to receive the EVERYbody Project or a video-based, low-dissonance comparison intervention. RESULTS Around half of students (56%) held one or more specific socially marginalized identity (26% with a racial or ethnic identity other than white and non-Hispanic, 39% with a sexual identity other than straight, 7% with a gender identity other than cisgender). The EVERYbody Project produced greater reductions in three outcomes associated with poor body image (internalized appearance norms, body dissatisfaction, and negative affect) compared to the video intervention through 3-month follow-up (ps < .003) with medium between group effects. Both conditions experienced small reductions in eating disorder psychopathology over time. DISCUSSION Expert peer facilitation may be a viable delivery model for inclusive, diversity-focused dissonance-based body image programs. PUBLIC SIGNIFICANCE This study explored a novel facilitation approach for a diversity-focused body image program for college students. A brief (4 h) dissonance-based program was open to all college students and delivered by "expert" diverse peer leaders who were screened for facilitation readiness. Body image and related outcomes were improved through 3-month follow-up relative to a comparison condition, suggesting that expert peer facilitation may be a viable option for delivering universal, inclusive body image programming.
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Affiliation(s)
- Anna C Ciao
- Department of Psychology, Western Washington University, Bellingham, Washington, USA
| | - Ally Duvall
- Department of Psychology, Western Washington University, Bellingham, Washington, USA
| | - Summer Pascual
- Department of Psychology, Western Washington University, Bellingham, Washington, USA
| | - Kendall A Lawley
- Department of Psychology, Western Washington University, Bellingham, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Kambanis PE, Bottera AR, Mancuso CJ, Spoor SP, Anderson LM, Burke NL, Eddy KT, Forbush KT, Keith JF, Lavender JM, Mensinger JL, Mujica C, Nagata JM, Perez M, De Young KP. Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample. Int J Eat Disord 2022; 55:1690-1707. [PMID: 36054425 PMCID: PMC10263063 DOI: 10.1002/eat.23799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782). METHOD We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option. RESULTS Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections. DISCUSSION This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups. PUBLIC SIGNIFICANCE We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.
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Affiliation(s)
| | | | | | | | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
| | | | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Jill F. Keith
- Department of Family and Consumer Sciences, Human Nutrition and Food/Dietetics, University of Wyoming, Laramie, WY
| | - Jason M. Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD
- The Metis Foundation, San Antonio, TX
| | - Janell L. Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, Ft. Lauderdale, FL
| | - Christin Mujica
- Department of Psychology, University of Arkansas, Fayetteville, AK
| | - Jason M. Nagata
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Marisol Perez
- Department of Psychology, Arizona State University, Tempe, AZ
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24
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Riddle MC, Safer JD. Medical considerations in the care of transgender and gender diverse patients with eating disorders. J Eat Disord 2022; 10:178. [PMID: 36414965 PMCID: PMC9682795 DOI: 10.1186/s40337-022-00699-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
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Affiliation(s)
- Megan C Riddle
- Eating Recovery Center, 1231 116Th Ave NE, Bellevue, WA, 98004, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA.
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, 275 7Th Ave 12Th Floor, New York, NY, 10001, USA
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25
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de Oliveira Júnior ML, Almeida M, Santos CG, Brown TA, de Carvalho PHB. Psychometric properties of the eating disorder examination questionnaire among Brazilian cisgender gay and bisexual adult men. Int J Eat Disord 2022; 56:736-746. [PMID: 36380662 DOI: 10.1002/eat.23853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE One of the most widely used assessment tools for disordered eating attitudes and behaviors, the Eating Disorder Examination Questionnaire (EDE-Q), has not yet been evaluated in Brazilian cisgender gay and bisexual men-an at-risk population given the extent of minority stressors in Brazilian culture. The present study aimed to assess the psychometric properties of the EDE-Q among Brazilian cisgender gay and bisexual adult men. METHOD The Brazilian EDE-Q was administered to a sample of 1409 gay and bisexual adult men, along with measures of self-objectification, body-ideal internalization, drive for muscularity, muscle dysmorphia symptoms, and body appreciation. The factor structure of the Brazilian EDE-Q was assessed using a two-step, split-sample exploratory (EFA; n = 704) and confirmatory factor analytic approach (CFA; n = 705). Additionally, convergent validity, internal consistency, and 2-week test-retest reliability were assessed. RESULTS Findings from an EFA and CFA revealed a one-factor structure with 22 items and adequate internal consistency (ω = .92, 95% CI = [.91, .93]). Moreover, the scale demonstrated good 2-week test-retest reliability (ICC = .86, 95% CI = [.82, .88], p < .001). The EDE-Q scores showed positive associations with self-objectification, body-ideal internalization, muscle dysmorphia symptoms, and drive for muscularity, as well as a negative association with body appreciation. DISCUSSION Results provide support for the use of the EDE-Q using a one-factor structure in Brazilian cisgender gay and bisexual adult men and give insights for future studies on eating disorders in sexual minorities in Latin America. PUBLIC SIGNIFICANCE The Eating Disorder Examination Questionnaire (EDE-Q) is one of the most widely used self-report measures of eating disorder symptoms. However, there is a lack of research on the validity and reliability of the EDE-Q in Latin American countries. This study evaluated the validity and reliability of the EDE-Q in Brazilian cisgender gay and bisexual adult men. Our findings give insights for future studies on eating disorders in sexual minorities in Latin America.
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Affiliation(s)
| | - Maurício Almeida
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Cleonaldo Gonçalves Santos
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Pedro Henrique Berbert de Carvalho
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil.,AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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26
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Riddle MC, Robertson L, Blalock DV, Duffy A, Le Grange D, Mehler PS, Rienecke RD, Joiner T. Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals. Int J Eat Disord 2022; 55:1532-1540. [PMID: 36151729 DOI: 10.1002/eat.23812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to compare symptom severity of eating disorders (EDs), depression and anxiety at admission and discharge for transgender and nonbinary (TNB) individuals and cisgender adult individuals receiving treatment for EDs at higher levels of care (HLOC), adding to the limited research in this area. METHOD Participants were 25 TNB individuals and 376 cisgender individuals admitted to a HLOC ED treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9, and Beck Anxiety Inventory at admission and discharge. RESULTS TNB individuals showed significant improvements on EDE-Q global scores between admission and discharge (Cohen's d = 1.27), and showed similar improvements on the EDE-Q over the course of treatment (Cohen's d = 0.06) when compared to cisgender individuals. TNB individuals had more severe depression at admission (Cohen's d = 0.61). Although depression improved over the course of treatment for both groups, TNB individuals showed less improvement (Cohen's d = 0.59). Suicidality was higher for TNB individuals on admission and discharge and did not improve significantly over the course of treatment (Cohen's d = 0.38). DISCUSSION This study provides preliminary evidence that TNB and cisgender individuals show similar improvement in ED symptoms during HLOC treatment. However, TNB individuals have more severe depression and less improvement in depression compared to cisgender individuals, without improvement in suicidality. TNB individuals may benefit from care targeting depression and suicidality during ED treatment. PUBLIC SIGNIFICANCE STATEMENT TNB individuals have increased risk of EDs. Little research addresses how TNB individuals respond to ED treatment, which was traditionally created for cisgender individuals. We present one of the first studies examining ED treatment outcomes for TNB adults. TNB individuals showed improved ED symptoms with treatment, but less improvement in depression and their suicidality remained elevated. This suggests the need for targeted treatment.
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Affiliation(s)
- Megan C Riddle
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Bellevue, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA.,ACUTE at Denver Health, Denver, Colorado, USA.,Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Nagata JM, Compte EJ, McGuire FH, Lavender JM, Murray SB, Brown TA, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR. Psychometric validation of the Muscle Dysmorphic Disorder Inventory (MDDI) among U.S. transgender men. Body Image 2022; 42:43-49. [PMID: 35653965 PMCID: PMC10069164 DOI: 10.1016/j.bodyim.2022.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023]
Abstract
Muscle dysmorphia (MD) is characterized by a pervasive belief or fear of insufficient muscularity and an elevated drive for muscularity, representing the pathological and extreme pursuit of muscularity. Psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have yet to be evaluated in transgender men despite emerging evidence suggesting differential risk for MD symptoms in this population. In this study, we assessed the psychometric properties of the MDDI in a sample of 330 transgender men ages 18-67 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults in the U.S. Using a two-step, split-sample approach, an initial exploratory factor analysis supported a three-factor structure and a subsequent confirmatory factor analysis of a re-specified three-factor model demonstrated good overall fit (χ2/df = 1.84, CFI =0.94, TLI =0.92, RMSEA =0.07 [90% CI =0.05,.09], SRMR =0.08). Moreover, results supported the internal consistency and convergent validity of the MDDI subscales in transgender men. Findings inform the use of the MDDI among transgender men and provide a foundation to support further work on the MDDI and MD symptoms among gender minority populations.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Metis Foundation, San Antonio, TX, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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28
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Ganson KT, Cunningham ML, Pila E, Rodgers RF, Murray SB, Nagata JM. Characterizing cheat meals among a national sample of Canadian adolescents and young adults. J Eat Disord 2022; 10:113. [PMID: 35933394 PMCID: PMC9357326 DOI: 10.1186/s40337-022-00642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "Cheat meals", described as brief eating episodes that depart from established dietary practices to consume prohibited foods, represent a novel and increasingly common eating behavior with particular salience in adolescence and young adulthood. However, knowledge gaps remain regarding the frequency and characterization of foods and calories consumed during cheat meals, and their associations with eating disorder behaviors and psychopathology. Thus, the aims of this study were to delineate engagement in cheat meals among a large, national sample of Canadian adolescents and young adults. METHODS Participants (N = 2,717) were from the Canadian Study of Adolescent Health Behaviors. Frequencies of engagement in cheat meals, and associated foods and calories consumed, in the past 12 months and 30 days were determined. The associations between engagement in cheat meals and eating disorder behaviors and psychopathology were determined using modified Poisson regression analyses. RESULTS Engagement in cheat meals in the past 12 months was highest among men (60.9%) compared to women (53.7%) and transgender/gender non-conforming (TGNC; 52.5%) participants. Cheat meals consisting between 1,000 and 1,499 cal were those most frequently reported among all participants. Mean number of cheat meals in the past 12 months was equivalent to > 1 per week, which was similar to engagement in the past 30 days. Finally, engagement in cheat meals in the past 12 months and 30 days was associated with patterns of eating disorder behaviors and psychopathology among all participants, including binge-eating-related behaviors. CONCLUSIONS This study further characterized and extended knowledge of cheat meal engagement across genders, aligning with prior research by demonstrating that engagement is associated with greater eating disorder psychopathology. Findings from this study add to the growing characterization of the novel behavioral phenomenon of cheat meals. Specifically, over half of adolescents and young adults across all 13 provinces and territories in Canada reported engaging in > 1 cal dense cheat meal per week, over the past 12 months. Despite the normalization and promotion of cheat meal engagement among the general public and unique fitness communities, engagement in this behavior is linked to greater eating disorder behaviors and psychopathology, including binge-eating episodes. Our findings emphasize the need for further research, public awareness, and clinical interventions aimed at addressing this potentially harmful eating behavior.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | | | - Eva Pila
- School of Kinesiology, Western University, London, ON, Canada
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
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29
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Compte EJ, Cattle CJ, Lavender JM, Brown TA, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR, Nagata JM. Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people. J Eat Disord 2022; 10:95. [PMID: 35794647 PMCID: PMC9260975 DOI: 10.1186/s40337-022-00618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study. METHODS We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study. RESULTS Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating. CONCLUSIONS These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
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Horstmann S, Schmechel C, Palm K, Oertelt-Prigione S, Bolte G. The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7493. [PMID: 35742742 PMCID: PMC9224188 DOI: 10.3390/ijerph19127493] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.
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Affiliation(s)
- Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany;
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Corinna Schmechel
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (C.S.); (K.P.)
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (C.S.); (K.P.)
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Sex- and Gender-Sensitive Medicine Unit, University of Bielefeld, 33615 Bielefeld, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany;
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Ferrucci KA, Lapane KL, Jesdale BM. Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims. Int J Eat Disord 2022; 55:801-809. [PMID: 35524487 PMCID: PMC9167760 DOI: 10.1002/eat.23729] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We estimated the prevalence of diagnosed eating disorders, overall and by select demographics, among commercially insured individuals identified as transgender in a national claims database. METHODS From the 2018 IBM® MarketScan® Commercial Database, there were 10,415 people identifiable as transgender based on International Classification of Disease (ICD-10) codes and procedure codes, specific to gender-affirming care, from inpatient and outpatient claims. Eating disorders were identified from ICD-10 codes and included anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, avoidant restrictive feeding and intake disorder, and other specified feeding and eating disorders. We estimated the prevalence of specific eating disorders diagnoses by selecting patient characteristics. RESULTS Of individuals receiving some form of gender-affirming care, 2.43% (95% confidence interval: 2.14%-2.74%) were diagnosed with an eating disorder: 0.84% anorexia nervosa, 0.36% bulimia nervosa, 0.36% binge eating disorder, 0.15% avoidant restrictive feeding and intake disorder, 0.41% other specified feeding and eating disorders, and 1.37% with an unspecified eating disorder. Among transgender-identifiable patients aged 12-15 years, 5.60% had an eating disorder diagnosis, whereas 0.52% had an eating disorder diagnosis in patients aged 45-64 years. DISCUSSION In patients identifiable as transgender, with receipt of gender-affirming care, the prevalence of diagnosed eating disorders was low compared to extant self-reported data for eating disorder diagnosis in transgender individuals. Among this population, eating disorders were highest in adolescents and young adults. Clinically verified prevalence estimates for eating disorder diagnosis in transgender people with a history of gender-affirming care warrant further investigation. PUBLIC SIGNIFICANCE The present study aims to provide clinically validated, contemporary prevalence estimates for diagnosed eating disorders among a medically affirmed population of transgender adults and children in the United States. We report low prevalence of having any eating disorder relative to prevalence estimates reported in prior literature without clinical validation. These findings may be explained by access to affirming care and medical care generally.
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Affiliation(s)
- Katarina A Ferrucci
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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LaMarre A, Levine MP, Holmes S, Malson H. An open invitation to productive conversations about feminism and the spectrum of eating disorders (part 1): basic principles of feminist approaches. J Eat Disord 2022; 10:54. [PMID: 35440011 PMCID: PMC9020002 DOI: 10.1186/s40337-022-00532-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/02/2022] [Indexed: 12/17/2022] Open
Abstract
Despite the long history of feminist research in the field and the clear relevance of questions of gender to this sphere, many continue to question the relevance of feminism for understanding and treating eating disorders in 2022. In this set of two papers, we explore some of the tensions, omissions and misconceptions which surround feminist approaches to eating disorders. At the core of these two papers is our assertion that such approaches can make significant contributions in the eating disorders field along six key lines: enriching the science of eating disorders, unpacking diagnostics, contextualizing treatment and prevention, attending to lived experiences, diversifying methodologies, and situating recoveries. In this first paper, we outline what feminist approaches are and dig into some key tensions that arise when feminist approaches come to the table. These include critiques of sociocultural approaches to understanding eating disorders, the relationship between feminist approaches and biological and genetic attributions for eating disorders, and the role of men. We then offer a key contribution that feminist approaches have made to eating disorders scholarship: an invitation to unpack diagnostic approaches and situate eating disorders within the landscape of food, weight, and shape concerns in the twenty-first century.
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Affiliation(s)
- Andrea LaMarre
- School of Psychology, Massey University Auckland, Private Bag 102904, North Shore, Auckland, 0745, New Zealand.
| | | | - Su Holmes
- University of East Anglia, Norwich, UK
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Goel NJ, Burnette CB, Weinstock M, Mazzeo SE. Eating Disorder Examination-Questionnaire: Evaluating factor structures and establishing measurement invariance with Asian/Hawaiian/Pacific Islander, Black, and White American college men. Int J Eat Disord 2022; 55:481-493. [PMID: 35261058 PMCID: PMC9315007 DOI: 10.1002/eat.23696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study evaluated the factor structure and invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a sample of Asian/Hawaiian/Pacific Islander (n = 163), Black (n = 155), and White (n = 367) American university men. METHOD Twelve different EDE-Q factor structures reported in the literature were evaluated using multi-group confirmatory factor analyses, and measurement invariance assessed. RESULTS A respecified four-factor structure proposed by Parker et al. (2016) showed superior fit and was invariant across groups. Significant differences emerged across all latent factors, with small to medium effects. Asian/Hawaiian/Pacific Islander men reported significantly higher scores on factors assessing Appearance Concern, Overvaluation of Shape/Weight, and Eating Concerns, and were more likely to endorse regular objective binge eating (OBE) and fasting episodes than their Black and White peers. Both White and Asian/Hawaiian/Pacific Islander men reported greater dietary restraint than Black men. Among this sample, frequencies of regular compensatory exercise ranged from 10% to 16%, fasting 6% to 14%, and OBEs 1% to 10%. DISCUSSION Results provide further support for the use of alternate EDE-Q factor structures, especially among non-White men. In this study, Asian/Hawaiian/Pacific Islander men reported the highest levels of ED psychopathology relative to White and Black men, indicating they might be particularly vulnerable to EDs. PUBLIC SIGNIFICANCE This study failed to find support for using the original Eating Disorder Examination-Questionnaire four-factor structure to detect disordered eating in Asian, Black, and White American college men. An alternate model proposed by Parker et al. in 2016 may be more appropriate. Asian men also reported the highest levels of eating psychopathology relative to their peers, suggesting they may be at high risk for developing eating disorders.
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Affiliation(s)
- Neha J. Goel
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Carolyn Blair Burnette
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA,Division of Epidemiology and Community HealthSchool of Public Health, University of MinnesotaMinneapolisMinnesotaUSA
| | - Madison Weinstock
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Suzanne E. Mazzeo
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA,Department of PediatricsVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Ganson KT, Mitchison D, Rodgers RF, Cunningham ML, Murray SB, Nagata JM. Compulsive exercise among college students: 5-year time trends in prevalence and demographic, substance use, and mental health correlates. Eat Weight Disord 2022; 27:717-728. [PMID: 34024038 DOI: 10.1007/s40519-021-01210-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/08/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To provide 5-year time trends in prevalence and demographic, substance use, and mental health correlates of compulsive exercise among a national sample of college men and women. METHODS We analyzed 4 academic survey years (2016-2020; N = 8251) of the national (USA) Healthy Minds Study. Compulsive exercise was measured by self-report of any occurrence of "compulsive" exercise in the past 4 weeks. Unadjusted prevalence of compulsive exercise in the past 4 weeks was estimated across the 4 survey years by sex. Multiple logistic regression analyses were conducted among the pooled sample and stratified by sex to estimate the associations between compulsive exercise in the past 4 weeks and demographic, substance use, and mental health correlates. RESULTS Among the pooled sample, 11% (95% confidence interval [CI] 9.60-12.42%) of men and 17% (95% CI 15.86-18.24%) of women reported compulsive exercise in the past 4 weeks. Prevalence across the 4 survey years remained stable among men and women. Higher body mass index was associated with greater odds of any compulsive exercise in the past 4 weeks among men, while any sports participation was associated with greater odds of any compulsive exercise in the past 4 weeks among women. Compulsive exercise in the past 4 weeks was associated with greater odds of all mental health symptoms and illicit drug use among men and women, and higher odds of alcohol use among women. CONCLUSION Compulsive exercise is relatively common among college men and women and is associated with substance use behaviors and poor mental health symptoms. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | - Deborah Mitchison
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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36
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Burnette CB, Luzier J, Bennett BL, Weisenmuller C, Kerr P, Martin S, Keener J, Calderwood L. Concerns and recommendations for using Amazon MTurk for eating disorder research. Int J Eat Disord 2022; 55:263-272. [PMID: 34562036 PMCID: PMC8992375 DOI: 10.1002/eat.23614] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our original aim was to validate and norm common eating disorder (ED) symptom measures in a large, representative community sample of transgender adults in the United States. We recruited via Amazon Mechanical Turk (MTurk), a popular online recruitment and data collection platform both within and outside of the ED field. We present an overview of our experience using MTurk. METHOD Recruitment began in Spring 2020; our original target N was 2,250 transgender adults stratified evenly across the United States. Measures included a demographics questionnaire, the Eating Disorder Examination-Questionnaire, and the Eating Attitudes Test-26. Consistent with current literature recommendations, we implemented a comprehensive set of attention and validity measures to reduce and identify bot responding, data farming, and participant misrepresentation. RESULTS Recommended validity and attention checks failed to identify the majority of likely invalid responses. Our collection of two similar ED measures, thorough weight history assessment, and gender identity experiences allowed us to examine response concordance and identify impossible and improbable responses, which revealed glaring discrepancies and invalid data. Furthermore, qualitative data (e.g., emails received from MTurk workers) raised concerns about economic conditions facing MTurk workers that could compel misrepresentation. DISCUSSION Our results strongly suggest most of our data were invalid, and call into question results of recently published MTurk studies. We assert that caution and rigor must be applied when using MTurk as a recruitment tool for ED research, and offer several suggestions for ED researchers to mitigate and identify invalid data.
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Affiliation(s)
| | - Jessica Luzier
- Charleston Area Medical Center – Institute for Academic Medicine,West Virginia University School of Medicine-Charleston Division; Department of Behavioral Medicine and Psychiatry
| | - Brooke L. Bennett
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Chantel Weisenmuller
- Charleston Area Medical Center – Institute for Academic Medicine,West Virginia University School of Medicine-Charleston Division; Department of Behavioral Medicine and Psychiatry
| | - Patrick Kerr
- Charleston Area Medical Center – Institute for Academic Medicine,West Virginia University School of Medicine-Charleston Division; Department of Behavioral Medicine and Psychiatry
| | | | - Jillian Keener
- Charleston Area Medical Center – Institute for Academic Medicine,West Virginia University School of Medicine-Charleston Division; Department of Behavioral Medicine and Psychiatry
| | - Lisa Calderwood
- Charleston Area Medical Center – Institute for Academic Medicine
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Giacomelli G, Meriggiola MC. Bone health in transgender people: a narrative review. Ther Adv Endocrinol Metab 2022; 13:20420188221099346. [PMID: 35651988 PMCID: PMC9150228 DOI: 10.1177/20420188221099346] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/21/2022] [Indexed: 12/29/2022] Open
Abstract
Bone health in transmen and transwomen is an important issue that needs to be evaluated by clinicians. Prior to gender-affirming hormone treatment (GAHT), transwomen have lower bone mineral density (BMD) and a higher prevalence of osteopenia than cismen probably related to external factors, such as hypovitaminosis D and less physical activities. Gonadotropin-releasing hormone (GnRH) analogues in transgender youth may cause bone loss; however, the addition of GAHT restores or at least improves BMD in both transboys and transgirls. The maintenance or increase in BMD shown in short-term longitudinal studies emphasizes that GAHT does not have a negative effect on BMD in adult transwomen and transmen. Gonadectomy is not a risk factor if GAHT is taken correctly. The prevalence of fractures in the transgender population seems to be the same as in the general population but more studies are required on this aspect. To evaluate the risk of osteoporosis, it is mandatory to define the most appropriate reference group not only taking into consideration the medical aspects but also in respect of the selected gender identity of each person.
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Affiliation(s)
- Giulia Giacomelli
- Division of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria Di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
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Halbeisen G, Brandt G, Paslakis G. A Plea for Diversity in Eating Disorders Research. Front Psychiatry 2022; 13:820043. [PMID: 35250670 PMCID: PMC8894317 DOI: 10.3389/fpsyt.2022.820043] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/21/2022] [Indexed: 12/22/2022] Open
Abstract
Eating disorders (EDs) are often stereotyped as affecting the SWAG, that is, as affecting mostly skinny, White, affluent girls. Over the last decade, however, significant progress has been made toward increasing diversity in ED research. There is consensus that EDs affect individuals of all genders, ages, sexual orientations, ethnic, and socio-economic backgrounds, with recent studies exploring social determinants of ED etiology, ED presentation, and developing diversity-affirming ED assessments. This article provides a brief summary of current developments related to diversity as a research theme, and proposes different perspectives toward further improving diversity in ED research. Specifically, we argue for exploring the role of diversity in ED treatment settings and outcomes, for pursuing diversity-oriented research pro-actively rather than as a reaction to issues of under-representation, and for integrating diversity across different areas of medical education and trainings in psychotherapy. Limitations with respect to the paucity of research, and the link between diversity as a research theme and ED-related workforce diversity are discussed.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
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Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr 2021; 24:6436-6449. [PMID: 33866993 PMCID: PMC11148592 DOI: 10.1017/s1368980021001671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the literature and identify main themes, methods and results of studies concerning food and nutrition addressed in research on transgender populations. DESIGN A systematic review conducted through July 2020 in the MedLine/PubMed, Scopus and Web of Science databases. RESULTS Of the 778 studies identified in the databases, we selected thirty-seven. The studies were recent, most of them published after 2015, being produced in Global North countries. The most often used study design was cross-sectional; the least frequently used study design was ethnographic. Body image and weight control were predominant themes (n 25), followed by food and nutrition security (n 5), nutritional status (n 5), nutritional health assistance (n 1) and emic visions of healthy eating (n 1). CONCLUSIONS The transgender community presents body, food and nutritional relationships traversed by its unique gender experience, which challenges dietary and nutritional recommendations based on the traditional division by sex (male and female). We need to complete the lacking research and understand contexts in the Global South, strategically investing in exploratory-ethnographic research, to develop categories of analysis and recommendations that consider the transgender experience.
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Affiliation(s)
- Sávio Marcelino Gomes
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, 59056-000 Natal, Natal, Rio Grande do Norte, Brazil
- Laboratório Horta Comunitária Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte, 59078-970 Natal, Natal, Rio Grande do Norte, Brazil
| | - Michelle Cm Jacob
- Laboratório Horta Comunitária Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte, 59078-970 Natal, Natal, Rio Grande do Norte, Brazil
| | - Cecília Rocha
- Centre for Studies in Food Security, School of Nutrition, Ryerson University, Toronto, ONM5B 2K3, Canada
| | - Maria Fa Medeiros
- Laboratório Horta Comunitária Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte, 59078-970 Natal, Natal, Rio Grande do Norte, Brazil
| | - Clélia O Lyra
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, 59056-000 Natal, Natal, Rio Grande do Norte, Brazil
| | - Luiz Ra Noro
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, 59056-000 Natal, Natal, Rio Grande do Norte, Brazil
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Examining the elevated risk of COVID-19 in transgender communities with an intersectional lens. SN SOCIAL SCIENCES 2021; 1:249. [PMID: 34693307 PMCID: PMC8492083 DOI: 10.1007/s43545-021-00255-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/07/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 has presented unique and unprecedented struggles for all people, yet they tend to be magnified among marginalized communities. Indeed, in the United States, transgender (trans) people experience oppression in many facets of their lives, which places them at an increased risk for both COVID-19 exposure and complications. This oppression can be broadly categorized into two distinct, yet interrelated categories: health disparities (e.g., decreased immune health) and structural barriers (e.g., employment discrimination, policing). Recent scholarship has examined trans people’s risk for COVID-19 exposure and mortality, however few articles examine intersectional identities, and, to our knowledge, none have interrogated oppressive power structures (e.g., the prison industrial complex). We aim to fill these critical gaps and argue that it is imperative for cisgender people to partner with trans communities to dismantle these harmful systems, positively impacting the lives of trans individuals during the pandemic and beyond. We make several key recommendations for researchers, policymakers, healthcare workers, and allies to do so.
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Murray HB, Dreier MJ, Zickgraf HF, Becker KR, Breithaupt L, Eddy KT, Thomas JJ. Validation of the nine item ARFID screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. Int J Eat Disord 2021; 54:1782-1792. [PMID: 33884646 PMCID: PMC8492485 DOI: 10.1002/eat.23520] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) has three subscales aligned with ARFID presentations but clinically validated cutoff scores have not been identified. We aimed to examine NIAS subscale (picky eating, appetite, fear) validity to: (1) capture clinically-diagnosed ARFID presentations; (2) differentiate ARFID from other eating disorders (other-ED); and (3) capture ARFID symptoms among individuals with ARFID, individuals with other-ED, and nonclinical participants. METHOD Participants included outpatients (ages 10-76 years; 75% female) diagnosed with ARFID (n = 49) or other-ED (n = 77), and nonclinical participants (ages 22-68 years; 38% female, n = 40). We evaluated criterion-related concurrent validity by conducting receiver operating curve (ROC) analyses to identify potential subscale cutoffs and by testing if cutoffs could capture ARFID with and without use of the Eating Disorder Examination-Questionnaire (EDE-Q). RESULTS Each NIAS subscale had high AUC for capturing those who fit versus do not fit each ARFID presentation, resulting in proposed cutoffs of ≥10 (sensitivity = .97, specificity = .63), ≥9 (sensitivity = .86, specificity = .70), and ≥ 10 (sensitivity = .68, specificity = .89) on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively. ARFID versus other-ED had high AUC on the NIAS-picky eating (≥10 proposed cutoff), but not NIAS-appetite or NIAS-fear subscales. NIAS subscale cutoffs had a high association with ARFID diagnosis, but only correctly classified other-ED in combination with EDE-Q Global <2.3. DISCUSSION To screen for ARFID, we recommend using a screening tool for other-ED (e.g., EDE-Q) in combination with a positive score on any NIAS subscale (i.e., ≥10, ≥9, and/or ≥10 on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively).
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Affiliation(s)
- Helen Burton Murray
- Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Melissa J. Dreier
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Hana F. Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men. Eat Weight Disord 2021; 26:2227-2239. [PMID: 33270173 PMCID: PMC8437880 DOI: 10.1007/s40519-020-01070-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q). METHODS Participants were cisgender bisexual plus women (n = 462) and men (n = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people. RESULTS Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18-25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18-26 years) reported higher weight concern subscale scores than previously published in young men. CONCLUSIONS These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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Ruppert R, Kattari SK, Sussman S. Review: Prevalence of Addictions among Transgender and Gender Diverse Subgroups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168843. [PMID: 34444595 PMCID: PMC8393320 DOI: 10.3390/ijerph18168843] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022]
Abstract
We conducted an analysis of the prevalence of substance and behavioral addictions across different transgender and gender diverse (TGD) subgroups. We performed a scoping review using MEDLINE and Google Scholar databases and examined 12 addictions, including alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, internet, sex, love, exercise, work, and shopping. We presented prevalence rates for each addiction as a function of an individual’s gender identity (stratified into transgender females, transgender males, and gender nonconforming), and used cisgender women and men as reference groups. We included 55 studies in our final analysis, the majority of which investigated substance use disorders among TGD subgroups. Overall findings indicated that substantial differences in substance use exist among US TGD subgroups. There were far fewer publications that examined the prevalence of behavioral addictions across TGD subgroups. However, despite limited research in this area, findings still suggest that notable differences in behavioral addictions may exist between individual TGD subgroups. The conclusions of our review may provide clinicians with a better ability to screen for and treat at-risk individuals within the TGD community.
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Affiliation(s)
- Ryan Ruppert
- Keck School of Medicine of USC, Los Angeles, CA 90033, USA;
- Correspondence: or ; Tel.: +1-302-358-6852
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Steve Sussman
- Keck School of Medicine of USC, Los Angeles, CA 90033, USA;
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Nowaskie DZ, Filipowicz AT, Choi Y, Fogel JM. Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation. Int J Eat Disord 2021; 54:1493-1499. [PMID: 33990998 DOI: 10.1002/eat.23539] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Past studies have reported high rates of eating disorder (ED) symptomatology among transgender people, yet without consideration of gender affirmation. The primary objective of this study was to evaluate the relationship between gender identity, gender affirming interventions such as gender affirming hormones (GAH) and gender affirming surgeries (GAS), and ED symptomatology. METHOD Transgender patients at a primary care outpatient gender health program in the United States completed a survey consisting of demographics, medical history, and clinical variables, including the Eating Disorder Examination Questionnaire (EDE-Q). Multivariate analyses of covariance were conducted to compare EDE-Q scores across gender identity and gender affirmation. RESULTS Compared to transgender men (n = 79), transgender women (n = 87) reported higher EDE-Q scores and significantly higher Eating Concern. Compared to hormone/surgery-naïve and hormone-experienced/surgery-naïve patients, hormone/surgery-experienced patients had lower EDE-Q scores. Hormone/surgery-experienced patients reported significantly lower Shape Concern and marginally lower Global Score and Weight Concern than hormone-experienced/surgery-naïve patients. There were no differences in EDE-Q scores between hormone/surgery-naïve and hormone-experienced/surgery-naïve patients. DISCUSSION Transgender patients report high levels of ED symptomatology. There are subtle, yet important, differences in ED between gender identities and gender affirmations. High ED prevalence may result from the dual pathways of sociocultural pressures as well as gender dysphoria. Both GAH and GAS may be effective interventions to support gender affirmation and thereby alleviate ED symptomatology. While the potential positive benefits of GAS on ED are more apparent, the effects of GAH are less clear.
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Affiliation(s)
- Dustin Z Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew T Filipowicz
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yena Choi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Janine M Fogel
- Gender Health Program, Eskenazi Health, Indianapolis, Indiana, USA
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Predictors of eating-related psychopathology in transgender and gender nonbinary individuals. Eat Behav 2021; 42:101527. [PMID: 34049054 PMCID: PMC8380626 DOI: 10.1016/j.eatbeh.2021.101527] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/05/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Research examining the prevalence and severity of eating-related psychopathology in transgender and gender nonbinary individuals is limited. This study examined how identity development and minority stress relate to the presence of disordered eating behaviors and cognitions in transgender and gender nonbinary individuals, and improvement at one-year follow-up. METHODS Data come from a multi-site, longitudinal study of transgender and gender nonbinary individuals (n = 287) and includes assessment of transgender congruence, receipt of gender-affirming care, minority stress, and disordered eating symptoms. Hierarchical multivariable logistic regression was used to test for associations between identity development, minority stress, and eating-related psychopathology. RESULTS Eighty-three participants (28.9%) met criteria for current eating-related psychopathology. Loss of control eating was the most commonly endorsed behavior, followed by laxative, diuretic, or other medication use, and compulsive exercise. Higher transgender congruence was associated with lower odds of disordered eating symptoms (OR = 0.72, 95% CI 0.55-0.94), whereas increased internalized transphobia was associated with greater odds of disordered eating symptoms (OR = 1.41, 95% CI = 1.04-1.91). Participants with eating-related psychopathology had greater odds of having received gender-affirming psychotherapy in the year prior to assessment (OR = 2.33, 95% CI = 1.32-4.14). CONCLUSIONS Results suggest that gender identity development and internalized transphobia are associated with eating-related psychopathology in transgender and gender nonbinary individuals. Mental health providers should consider assessing all transgender and gender nonbinary individuals for eating-related psychopathology and unique risk factors associated with disordered eating, including low transgender congruence and internalized transphobia.
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Body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. Eat Weight Disord 2021; 26:1915-1925. [PMID: 33063287 DOI: 10.1007/s40519-020-01040-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards. PURPOSE This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. METHODS Participants (n = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology RESULTS: Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology CONCLUSION: Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals' gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Cusack CE, Cooper M, Libbey N, Galupo MP. Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress. Eat Behav 2021; 42:101544. [PMID: 34358854 DOI: 10.1016/j.eatbeh.2021.101544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Ruminative thought patterns, defined as repetitive negative self-focused attention, are considered an avoidant coping strategy for managing stress. As trans and nonbinary (TNB) individuals commonly experience prejudice and discrimination in response to their gender identities (i.e. minority stressors), rumination over these stressors may contribute to heightened risk of psychopathology in these groups. Although rumination is a general risk factor for eating disorder (ED) psychopathology, no studies to date have examined whether eating- or gender-related ruminative patterns relate to maintenance of ED psychopathology for TNB individuals. This cross-sectional study investigated whether levels of rumination (both gender-related and ED-specific) mediated the relationship between minority stress and ED psychopathology. METHOD Participants were 242 TNB adults (Mage = 24.92, SD = 6.5, Range = 18-70) recruited online, who completed measures of minority stress, gender-related rumination, ED-specific rumination, and ED psychopathology. We used Preacher-Hayes' approach to examine the parallel mediation model, with gender-related and ED-specific rumination as potential mediators. RESULTS Gender-related rumination did not mediate the relation between gender minority stress and ED psychopathology, Indirect B = -0.00 [95% BCa CI: -0.01, 0.00]; however, ED-specific rumination was significant, indicating partial mediation, Indirect B = 0.01 [95% BCa CI: 0.00, 0.02]. CONCLUSION As gender minority stress and ED-specific rumination relate to ED psychopathology, it is essential that clinicians adopt an intersectional minority stress framework in understanding ED psychopathology among TNB individuals.
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Duffy ME, Calzo JP, Lopez E, Silverstein S, Joiner TE, Gordon AR. Measurement and construct validity of the Eating Disorder Examination Questionnaire Short Form in a transgender and gender diverse community sample. Psychol Assess 2021; 33:459-463. [PMID: 33646808 PMCID: PMC8756775 DOI: 10.1037/pas0000996] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluated the measurement and construct validity of the Eating Disorder Examination Questionnaire Short Form (EDE-QS) in a transgender and gender diverse sample. Participants who self-identified as transgender and gender diverse (N = 71) completed self-report measures of demographics, gender-related experiences, and disordered eating/body image. Analyses comprised evaluation of EDE-QS internal consistency, convergent validity, and specificity for disordered eating. The EDE-QS demonstrated strong internal consistency in the full sample, in participants with and without suspected eating disorders, and in each gender identity group; and correlated significantly with indices of disordered eating and body image. The full scale and each item significantly differentiated between participants with and without suspected eating disorders. This study provides initial evidence for good measurement and construct validity of the EDE-QS as applied to transgender and gender diverse individuals. Findings offer the EDE-QS as a promising, brief tool for screening and/or population-based research related to disordered eating in this high-risk, yet underserved population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Mary E. Duffy
- Florida State University, Tallahassee, FL, United States
| | - Jerel P. Calzo
- San Diego State University, San Diego, CA, United States
| | - Ethan Lopez
- Trans Folx Fighting Eating Disorders, San Diego, CA, United States
| | | | | | - Allegra R. Gordon
- Boston University School of Public Health, Boston, MA, United States
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
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Gorrell S, Le Grange D, Blalock DV, Mehler PS, Johnson C, Manwaring J, Duffy A, Huston E, McClanahan S, Rienecke RD. Gender identity, race/ethnicity and eating pathology in a treatment-seeking community sample. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2021; 31:77-89. [PMID: 36703863 PMCID: PMC9876537 DOI: 10.1016/j.jbct.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite the wide-reaching impact of eating disorders (EDs), less is known about eating pathology among individuals across racial/ethnic groups whose gender identity differs from the binary categorization. Examining ED pathology both across binary and minority-gender groups, and relative to racial/ethnic identification is necessary to inform screening and culturally-sensitive intervention efforts. This study investigated patterns of ED symptomology among youth and adults (N = 13658) who telephoned treatment centers in the United States when seeking clinical support for ED symptoms. Analyses examined data from participants who completed a semi-structured clinical interview. Results indicated that Anorexia nervosa was the most common diagnosis in each gender category and for a majority of race/ethnic groups; Black individuals had elevated rates of binge eating disorder. Compared to females, males were less likely to endorse all ED symptoms (ps < .001); gender minority status was also associated with decreased report of a majority of ED symptoms. Asian and Black individuals were less likely than Whites to endorse most ED symptoms. When compared to Whites, Hispanic/Latinx and Bi/Multi-racial participants did not demonstrate significant differences in presentation across a majority of ED symptoms. Overall findings suggest individuals with female gender and White race may seek treatment from an ED treatment facility with greater frequency than other demographic groups. Noted exceptions include Hispanic/Latinx and Bi/Multi-racial individuals, for whom ED pathology may be represented comparably to Whites. While findings confirm traditional patterns in gender and racial/ethnic representation in EDs, current study findings also underscore that EDs are not culture bound.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA,ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA,University of Colorado School of Medicine, Denver, CO, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Emma Huston
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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50
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Nagata JM, Compte EJ, Cattle CJ, Flentje A, Capriotti MR, Lubensky ME, Murray SB, Obedin-Maliver J, Lunn MR. Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations. J Eat Disord 2020; 8:74. [PMID: 33292636 PMCID: PMC7722313 DOI: 10.1186/s40337-020-00352-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Gender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations. METHODS The participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people. RESULTS We present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18-26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise. CONCLUSIONS Gender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
| | - Emilio J Compte
- Eating Behavior Research Center School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew R Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychology, San José State University, San Jose, CA, USA
| | - Micah E Lubensky
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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