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Saunders JF, Nutter S, Waugh R, Hayden KA. Testing body-related components of objectification theory: A meta-analysis of the relations between body shame, self-objectification, and body dissatisfaction. Body Image 2024; 50:101738. [PMID: 38850716 DOI: 10.1016/j.bodyim.2024.101738] [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: 12/02/2023] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
Objectification theory has been instrumental in better understanding risk for eating disorders, depression, and sexual dysfunction, with self-objectification and body shame as serial mediators leading to these outcomes. Although originally proposed to explain these mental health outcomes in heterosexual women, researchers have extended objectification theory to individuals of various ages, racial identities, and sexual and gender identities. We conducted a systematic literature review of empirical peer-reviewed published research examining the relationship between the constructs of self-objectification, body dissatisfaction, and body shame in adult, youth, and LGBTQ+ samples. Our search yielded 5200 results, of which 318 met inclusion criteria. Of the papers included in this review, 26 reported correlations with sexual and gender diverse samples, 43 reported correlations with youth samples, and 249 reported correlations with samples of general adults (non-sexual or gender minorities). The meta-analyses yielded significant, moderate, positive correlations between body dissatisfaction and self-objectification, and between body shame and self-objectification, for each of the sub-samples. The majority of samples were predominantly White and cisgender female, suggesting the need for additional research examining these constructs among racial and gender minority populations. Overall, the results of this review highlight the unique contributions of body shame and body dissatisfaction to self-objectifying behaviors, and identify the moderating role of race and gender in these interrelations.
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Affiliation(s)
- Jessica F Saunders
- Psychology Convening Group, Ramapo College of New Jersey, 505 Ramapo Valley Rd, Mahwah, NJ 07430, USA.
| | - Sarah Nutter
- Educational Psychology & Leadership Studies, University of Victoria, 3800 Finnerty Rd, Victoria, BC V8P 5C2, Canada.
| | - Rachel Waugh
- Educational Psychology & Leadership Studies, University of Victoria, 3800 Finnerty Rd, Victoria, BC V8P 5C2, Canada.
| | - K Alix Hayden
- Health Sciences Library, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
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2
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Brown TR, Jansen MO, Zhou AN, Moog D, Xie H, Liebesny KV, Xu KY, Lin BY, Deng WY. Co-occurring autism, ADHD, and gender dysphoria in children, adolescents, and young adults with eating disorders: an examination of pre- vs. post-COVID pandemic outbreak trends with real-time electronic health record data. Front Psychiatry 2024; 15:1402312. [PMID: 39228920 PMCID: PMC11370642 DOI: 10.3389/fpsyt.2024.1402312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024] Open
Abstract
Background Incidence rates of autism, attention-deficit/hyperactivity disorder (ADHD), and gender dysphoria (GD) are rising not only in the general population, but particularly among children, adolescents, and young adults with eating disorders (EDs). While ED rates have risen during the COVID pandemic, trends in co-occurring autism, ADHD, and GD have yet to be investigated in detail or at scale by way of large electronic medical record data. Objectives To investigate trends in rates of co-occurring autism, ADHD, and GD among children, adolescents, and young adults with EDs in years prior to and during the COVID-19 pandemic. Methods We utilized a de-identified multinational electronic health records database (TriNetX) with 48,558 individuals aged 5-26 diagnosed with eating disorders (EDs) at least twice between 2017 and 2022. The primary predictor variable differentiated between the years of each person's index (first) ED diagnosis (2017-2019 vs. 2020-2022). The primary outcome variable was the rate of new co-occurring psychiatric diagnoses of autism, ADHD, and GD in the year following each patient's first ED diagnosis. We applied propensity score-matched multivariable logistic regressions to compare primary outcomes between 2017-2019 and 2020-2022. Results Our analysis included 17,445 individuals diagnosed with EDs in 2017-2019 (8% autism, 13.5% ADHD, 1.9% GD) and 31,113 diagnosed with EDs in 2020-2022 (8% autism, 14.6% ADHD, 3.2% GD). After 1:1 propensity score matching, 17,202 individuals from the 2017-2019 cohort were matched to peers mirroring the 2020-2022 cohort. Those diagnosed in 2020-2022 showed a 19% (aOR[95%CI]=1.19[1.07-1.33]), 25% (aOR=1.25[1.04-1.49]), and 36% (aOR=1.36[1.07-1.74]) increase in odds for autism, ADHD, and GD diagnoses, respectively, within the 365 days after the index EDs diagnosis, compared to the 2017-2019 cohort. Discussion Rates of autism, ADHD, and GD are significantly higher in individuals with ED in the post-pandemic 2020-2022 cohort in comparison to the pre-pandemic 2017-2019 cohort, even after controlling for baseline levels of co-occurring psychiatric diagnoses. Such findings reveal a critical gap in our current understanding of the totality of ways in which COVID-19 may have impacted the onset and clinical course of EDs, autism, ADHD, and GD among children, adolescents, and young adults.
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Affiliation(s)
- Tashalee R. Brown
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California-Los Angeles (UCLA), Los Angeles, CA, United States
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California-Los Angeles (UCLA), Los Angeles, CA, United States
| | - Madeline O. Jansen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California-Los Angeles (UCLA), Los Angeles, CA, United States
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California-Los Angeles (UCLA), Los Angeles, CA, United States
| | - A. Ning Zhou
- San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Dominic Moog
- Washington University School of Medicine, St. Louis, MO, United States
| | - Hui Xie
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Katherine V. Liebesny
- Department of Psychiatry and Behavioral Medicine, Carilion Clinic - Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Kevin Y. Xu
- School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
- Department of Psychiatry, Division of Addiction Science, Prevention and Treatment, Washington University School of Medicine, St. Louis, MO, United States
| | - Binx Y. Lin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Medicine, Carilion Clinic - Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Wisteria Y. Deng
- Department of Psychology, Yale University, New Haven, CT, United States
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Baker JH, Freestone D, Cai K, Silverstein S, Urban B, Steinberg D. Eating Disorder Clinical Presentation and Treatment Outcomes by Gender Identity Among Children, Adolescents, and Young Adults. J Adolesc Health 2024; 75:254-260. [PMID: 38310504 DOI: 10.1016/j.jadohealth.2023.11.015] [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: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Current eating disorder treatment approaches for youth were developed for use with cisgender girls, which limits the understanding of effectiveness for cisgender boys and transgender and gender expansive (TGE) youth. Here, we compare treatment outcomes for cisgender boys and TGE youth with cisgender girls receiving family-based treatment for an eating disorder. METHODS Patients were aged 6-24 and either active in treatment or discharged from September 1, 2020, to November 1, 2022 (N = 1,235). Patient exposure to treatment varied given individualized length of treatment. Outcomes include eating disorder symptoms, depression, anxiety, suicidality, caregiver burden, and parental confidence in supervising treatment. Treatment outcomes for cisgender boys and TGE youth were compared with cisgender girls. RESULTS Patients included n = 975 cisgender girls, n = 152 cisgender boys, and n = 108 TGE youth. Anorexia nervosa was the most common diagnosis. Cisgender boys reported significantly lower eating disorder (b = -2.7 [-4.1, -1.3]), anxiety (b = -1.6 [-2.2, -0.9]), and depression (b = -1.7 [-2.4, -0.9]) symptoms at admission compared with cisgender girls. TGE patients had significantly higher anxiety (b = 1.08 [0.28, 1.91]) and depression (b = 1.72 [0.78, 2.65]) symptoms compared with cisgender girls. Cisgender boys started with significantly lower suicidal ideation (b = -1.28 [-2.19, -0.43]) and TGE patients with significantly higher suicidal ideation (b = 1.63 [0.76, 2.51]) than cisgender girls. All symptoms improved during treatment and improved at similar rates over time in treatment regardless of gender identity. DISCUSSION Early evidence from this study supports the use of family-based treatment for cisgender boys and TGE youth with eating disorders. Further research is needed on the long-term outcomes of this approach for youth of all genders.
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Affiliation(s)
| | | | - Kelly Cai
- Equip Health, Inc., Carlsbad, California
| | | | - Bek Urban
- Equip Health, Inc., Carlsbad, California
| | - Dori Steinberg
- Equip Health, Inc., Carlsbad, California; Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina
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Liddiard E, Hamshaw RJT. Body dissatisfaction and beyond: Investigating attitudes towards calorie labels on UK food menus. Appetite 2024; 199:107418. [PMID: 38754766 DOI: 10.1016/j.appet.2024.107418] [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] [Received: 12/20/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
In 2022 the British government made calorie labels on menus a legal requirement to encourage healthier food choices while dining out. Yet, little research has explored perceptions of calorie labels on menus in the United Kingdom or tested whether there may be groups of people vulnerable to potential negative effects of calorie labels, such as those with body dissatisfaction. This between-subjects, convergent mixed-methods study addressed these enquiries. Participants were 562 adults who completed an online survey where hypothetical food orders were made from a menu. The study found that participants who viewed a menu with calorie labels ordered fewer calories. Quantitative results did not find that participants with higher levels of body dissatisfaction were at significantly greater odds of using calorie labels to order fewer calories. However, our qualitative (thematic) analysis revealed that experiences of calorie labels could be shaped by body image concerns. Themes further drew on how calorie labels were empowering, but there were also concerns about their oversimplicity. Findings are discussed in relation to implications for future calorie labelling policies. Given the inconsistent findings amongst the limited amount of literature investigating the role of body dissatisfaction in how calorie labels are used, future research is crucial. In the meantime, as a cautionary measure, clinicians involved in supporting individuals with body or food-related concerns should be aware of the challenges their clients may experience in facing calorie labels on menus when dining out.
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Affiliation(s)
- Emma Liddiard
- Department of Psychology, University of Bath, Bath, UK
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5
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Cahill L, Malik M, Jones BA, Perera ATM, McDermott DT. Tackling bisexual erasure: An explorative comparison of bisexual, gay and straight cisgender men's body image. Body Image 2024; 51:101763. [PMID: 38970852 DOI: 10.1016/j.bodyim.2024.101763] [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: 03/26/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
Previous body image research often grouped both gay and bisexual men into a single category: sexual minoritised men, limiting our understanding of how sexual identity influences body image. However, there is strong reason to believe that bisexual and gay men experience distinct body image concerns. Here, we explored motivations to alter one's leanness and muscularity, as well as (dis)satisfaction with body fat, muscularity, height and penis size, and functionality appreciation across gay, bisexual, and straight cisgender men. We sampled 378 white participants aged 18 to 85 (nbisexual = 125, ngay = 128, nstraight = 125). We found that bisexual men were significantly less motivated to be lean and showed lower muscularity dissatisfaction relative to gay men but showed comparable levels to straight men. Our findings demonstrate that despite research perceiving the body image of bisexual and gay men as homogenous, they experience differences in their body image concerning leanness and muscularity dissatisfaction. Future body image research should incorporate this understanding by not artificially grouping bisexual and gay cisgender men and instead acknowledging the potential uniqueness in their experiences.
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Affiliation(s)
- Liam Cahill
- NTU Psychology, School of Social Sciences, Nottingham Trent University, England, UK.
| | - Mohammed Malik
- NTU Psychology, School of Social Sciences, Nottingham Trent University, England, UK
| | - Bethany A Jones
- NTU Psychology, School of Social Sciences, Nottingham Trent University, England, UK
| | | | - Daragh T McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, England, UK
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6
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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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7
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Turan Ş, Özulucan MT, Karataş U, Kavla Y, Koyuncu O, Durcan E, Durcan G, Bağhaki S. The effects of gender-affirming hormone therapy and mastectomy on psychopathology, body image, and quality of life in adults with gender dysphoria who were assigned female at birth. Qual Life Res 2024; 33:1937-1947. [PMID: 38656406 PMCID: PMC11176246 DOI: 10.1007/s11136-024-03664-6] [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] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Individuals with gender dysphoria (GD) may request hormone therapy and various surgical operations to change their physical characteristics. The present study aimed to investigate the effects of two treatments, mastectomy and gender-affirming hormone therapy (GAHT), on adults with GD who were assigned female at birth (GD AFAB). METHODS In this cross-sectional study, we gathered data from a total of 269 individuals in three groups: (a) untreated group (n = 121), (b) GAHT group (n = 84) who had been receiving treatment for at least 6 months, and (c) GAHT-MAST group (n = 64) who had been using GAHT for at least 6 months and had undergone mastectomy at least 3 months prior. All participants were asked to complete the Symptom Checklist-90-Revised (SCL-90-R), the Body Uneasiness Test (BUT), and the World Health Organization's Quality of Life Questionnaire- Brief Form, Turkish Version (WHOQOL-BREF-Tr). RESULTS We found that individuals in the untreated group had higher psychopathological symptoms and body uneasiness scores, and lower quality of life scores compared to both GAHT and GAHT-MAST groups. There was no difference in psychopathology between the GAHT-MAST group and the GAHT group, but body uneasiness scores were lower, and quality of life scores were higher in the GAHT-MAST group. CONCLUSION Our study suggests that individuals receiving GAHT improved mental health, body satisfaction, and overall quality of life. Combining mastectomy with GAHT may further enhance these benefits.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
| | - Mahmut Taha Özulucan
- Graduate School of Health Science, Neuroscience PhD Program, Koç University, Istanbul, Türkiye
| | - Uğur Karataş
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Yasin Kavla
- Department of Psychiatry, Hınıs State Hospital, Erzurum, Türkiye
| | - Oğuzhan Koyuncu
- Department of Child and Adolescent Psychiatry, Medeniyet University, Istanbul, Türkiye
| | - Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Gizem Durcan
- Department of Child and Adolescent Psychiatry, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Semih Bağhaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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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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9
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Soulliard ZA, Le TP, Yamasaki V. Pride and body image among transgender and nonbinary adults: the mediating role of body appreciation between gender identity pride and intuitive eating. Eat Disord 2024:1-18. [PMID: 38855897 DOI: 10.1080/10640266.2024.2365519] [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: 06/11/2024]
Abstract
Studies exploring disordered eating among transgender and nonbinary populations have primarily focused on minority stressors with a dearth of research examining the role of gender identity pride on body appreciation and intuitive eating. To address this gap in the literature, the present study, comprised of 148 transgender and nonbinary adults (Mage = 24.68, SD = 6.64), tested the associations among gender identity pride, body appreciation, and intuitive eating, controlling for demographics and minority stress variables. The study also tested body appreciation as a mediator in the cross-sectional association between gender identity pride and intuitive eating. Regression models indicated that greater gender identity pride was significantly associated with greater body appreciation, but not intuitive eating. Greater body appreciation was a significant mediator in the positive association between gender identity pride and intuitive eating. Findings support the significant role and relevance of examining gender identity pride as related to body appreciation and intuitive eating. Future research may determine the causal impact of gender identity pride on body image and eating behaviors in transgender and nonbinary populations. Clinicians may consider the positive role of gender identity pride when addressing body image and eating behaviors with their transgender and nonbinary clients.
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Affiliation(s)
| | - Thomas P Le
- Department of Psychology, Bryn Mawr College, Philadelphia, Pennsylvania, USA
- Department of Psychology, The University of Maryland, College Park, Maryland, USA
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10
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Oliveira J, Monteiro D, Jacinto M, Matos R, Amaro N, Rodrigues F, Antunes R. Physical Activity, Anxiety, Depression, and Body Image in Trans Individuals: An Exploratory Study. Healthcare (Basel) 2024; 12:1008. [PMID: 38786418 PMCID: PMC11121412 DOI: 10.3390/healthcare12101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Physical activity (PA), mental health, and body image are some important health topics in the transgender population that have been recently discussed and appear to play a crucial role in the quality of life of the trans population. This study aims to elucidate the complex interplay of these variables and their implications for the well-being of trans individuals. METHODS In a cross-sectional study, 75 Portuguese transgender individuals (M = 23.68; SD ± 6.59) were recruited to participate in this study. The participants completed three questionnaires related to the assessment of physical activity (IPAQ), depressive and anxious symptomatology (HADS), and satisfaction with body image (BISQp). RESULTS Trans individuals showed a total energy expenditure of 3316.40 metabolic equivalent tasks (METS), had a moderate level of anxiety symptomatology, and low levels of satisfaction with body image. Satisfaction with body image was negatively associated with anxiety (r = -0.441, p < 0.01) and depression symptomatology (r = -0.600, p < 0.01). CONCLUSIONS The implementation of inclusive programs that promote body acceptance and coping strategies, particularly within the context of physical exercise, may help alleviate distress related to body image dissatisfaction while also addressing underlying anxiety and depression symptoms.
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Affiliation(s)
- Joana Oliveira
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
| | - Diogo Monteiro
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Miguel Jacinto
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Rui Matos
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Nuno Amaro
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Filipe Rodrigues
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Raúl Antunes
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
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11
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Santi D, Spaggiari G, Marinelli L, Cacciani M, Scipio S, Bichiri A, Profeta A, Granata ARM, Simoni M, Lanfranco F, Manieri C, Ghigo E, Motta G. Gender-affirming hormone treatment: friend or foe? Long-term follow-up of 755 transgender people. J Endocrinol Invest 2024; 47:1091-1100. [PMID: 37889433 DOI: 10.1007/s40618-023-02220-2] [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: 04/12/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Gender-affirming hormone treatment (GAHT) is one of the main demands of transgender and gender diverse (TGD) people, who are usually categorised as transgender assigned-male-at birth (AMAB) and assigned-female-at birth (AFAB). The aim of the study is to investigate the long-term therapeutic management of GAHT, considering hormonal targets, treatment adjustments and GAHT safety. METHODS A retrospective, longitudinal, observational, multicentre clinical study was carried out. Transgender people, both AMAB and AFAB, were recruited from two Endocrinology Units in Italy (Turin and Modena) between 2005 and 2022. Each subject was managed with specific and personalized follow-up depending on the clinical practice of the Centre. All clinical data routinely collected were extracted, including anthropometric and biochemical parameters, lifestyle habits, GAHT regime, and cardiovascular events. RESULTS Three-hundred and two transgender AFAB and 453 transgender AMAB were included. Similar follow-up duration (p = 0.974) and visits' number (p = 0.384) were detected between groups. The transgender AFAB group reached therapeutic goals in less time (p = 0.002), fewer visits (p = 0.006) and fewer adjustments of GAHT scheme (p = 0.024). Accordingly, transgender AFAB showed a higher adherence to medical prescriptions compared to transgender AMAB people (p < 0.001). No significantly increased rate of cardiovascular events was detected in both groups. CONCLUSION Our real-world clinical study shows that transgender AFAB achieve hormone target earlier and more frequently in comparison to transgender AMAB individuals. Therefore, transgender AMAB people may require more frequent check-ups in order to tailor feminizing GAHT and increase therapeutic adherence.
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Affiliation(s)
- D Santi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
| | - G Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Cacciani
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Scipio
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Bichiri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - A Profeta
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - A R M Granata
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - M Simoni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - F Lanfranco
- Division of Endocrinology, Andrology and Metabolism, Department of Medical Sciences, Humanitas Gradenigo, University of Turin, Turin, Italy
| | - C Manieri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - G Motta
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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12
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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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13
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Alexander T, Burnette CB, Cory H, McHale S, Simone M. The need for more inclusive measurement to advance equity in eating disorders prevention. Eat Disord 2024:1-19. [PMID: 38488765 DOI: 10.1080/10640266.2024.2328460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.
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Affiliation(s)
- Tricia Alexander
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - C Blair Burnette
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Hannah Cory
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Department of Health Promotion and Community Health, School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
| | - Safiya McHale
- Department of Psychology, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO, USA
| | - Melissa Simone
- Department of Psychology, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO, USA
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14
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Li J, Feng Y, Yu Y, Xu S, Wang Y. Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study. BJPsych Open 2024; 10:e66. [PMID: 38482718 PMCID: PMC10951840 DOI: 10.1192/bjo.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance. AIMS The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety. METHOD A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants' gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality. RESULTS Among TGD young people, gender dysphoria was significantly positively associated with suicidality (β = 0.15, 95% CI = 0.11-0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (β = 0.07, 95% CI = 0.05-0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality. CONCLUSIONS Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.
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Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
| | - Yi Yu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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15
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Hamamoto Y, Oba K, Ishibashi R, Ding Y, Nouchi R, Sugiura M. Reduced body-image disturbance by body-image interventions is associated with neural-response changes in visual and social processing regions: a preliminary study. Front Psychiatry 2024; 15:1337776. [PMID: 38510808 PMCID: PMC10951070 DOI: 10.3389/fpsyt.2024.1337776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Body-image disturbance is a major factor in the development of eating disorders, especially among young women. There are two main components: perceptual disturbance, characterized by a discrepancy between perceived and actual body size, and affective disturbance, characterized by a discrepancy between perceived and ideal body size. Interventions targeting body-image disturbance ask individuals to describe their own body without using negative expressions when either viewing it in a mirror or imagining it. Despite the importance of reducing body-image disturbance, its neural mechanisms remain unclear. Here we investigated the changes in neural responses before and after an intervention. We hypothesized that neural responses correlated with the degree of body-image disturbance would also be related to its reduction, i.e., a reduction in perceptual and affective disturbances would be related to changes in attentional and socio-cognitive processing, respectively. Methods Twenty-eight young adult women without known psychiatric disorders underwent a single 40-min intervention. Participants completed tasks before and after the intervention, in which they estimated their perceived and ideal body sizes using distorted silhouette images to measure body-image disturbance. We analyzed the behavioral and neural responses of participants during the tasks. Results The intervention did not significantly reduce body-image disturbance. Analysis of individual differences showed distinct changes in neural responses for each type of disturbance. A decrease in perceptual disturbance was associated with bodily visuospatial processing: increased activation in the left superior parietal lobule, bilateral occipital gyri, and right cuneus. Reduced affective disturbance was associated with socio-cognitive processing; decreased activation in the right temporoparietal junction, and increased functional connectivity between the left extrastriate body area and the right precuneus. Discussion We identified distinct neural mechanisms (bodily visuospatial and socio-cognitive processing) associated with the reduction in each component of body-image disturbance. Our results imply that different neural mechanisms are related to reduced perceptual disturbance and the expression thereof, whereas similar neural mechanisms are related to the reduction and expression of affective disturbance. Considering the small sample size of this study, our results should be regarded as preliminary.
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Affiliation(s)
- Yumi Hamamoto
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kentaro Oba
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Ryo Ishibashi
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yi Ding
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- School of Medicine, Tohoku University, Sendai, Japan
| | - Rui Nouchi
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
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16
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Lundberg TR, Tucker R, McGawley K, Williams AG, Millet GP, Sandbakk Ø, Howatson G, Brown GA, Carlson LA, Chantler S, Chen MA, Heffernan SM, Heron N, Kirk C, Murphy MH, Pollock N, Pringle J, Richardson A, Santos-Concejero J, Stebbings GK, Christiansen AV, Phillips SM, Devine C, Jones C, Pike J, Hilton EN. The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes. Scand J Med Sci Sports 2024; 34:e14581. [PMID: 38511417 DOI: 10.1111/sms.14581] [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] [Received: 10/14/2023] [Revised: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 03/22/2024]
Abstract
The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.
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Affiliation(s)
- Tommy R Lundberg
- Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ross Tucker
- Department of Sport Science, Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | - Kerry McGawley
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - Alun G Williams
- Manchester Metropolitan Institute of Sport, Manchester Metropolitan University, Manchester, UK
- Institute of Sport, Exercise and Health, University College London, London, UK
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Øyvind Sandbakk
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Glyn Howatson
- Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Water Research Group, North West University, Potchefstroom, South Africa
| | - Gregory A Brown
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, Nebraska, USA
| | | | - Sarah Chantler
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Mark A Chen
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Shane M Heffernan
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Neil Heron
- Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Belfast, UK
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Christopher Kirk
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Marie H Murphy
- Physical Activity for Health Research Centre, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
- Centre for Exercise Medicine, Physical Activity and Health, School of Sport, Ulster University, Belfast, UK
| | - Noel Pollock
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jamie Pringle
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Richardson
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Jordan Santos-Concejero
- Department of Physical Education and Sport, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Georgina K Stebbings
- Manchester Metropolitan Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | | | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Carwyn Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jon Pike
- Department of Philosophy, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Emma N Hilton
- School of Biological Sciences, University of Manchester, Manchester, UK
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17
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Quiñones IC, Selkie E, Mammel KA, Haedt-Matt A, Klump KL, Burt SA, Van Huysse JL. Disordered eating in transgender and gender non-conforming youth: A comparison to community-based and clinical samples. EUROPEAN EATING DISORDERS REVIEW 2024; 32:338-349. [PMID: 37905947 DOI: 10.1002/erv.3045] [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] [Received: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE This study investigates eating pathology in transgender and gender non-conforming (TGNC) youth compared to a community-based sample and individuals with eating disorders (EDs). METHOD Participants (ages 13-21 years) included TGNC youth from a paediatric gender clinic (N = 97), a demographically matched community-based sample of cisgender males (N = 97) and cisgender females (N = 97), and treatment-seeking patients with EDs (N = 112). The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED cognitions and behaviours. RESULTS Transgender and gender non-conforming participants reported significantly higher EDE-Q global scores compared to the cisgender samples, but significantly lower than the ED sample. Transgender and gender non-conforming individuals reported a higher likelihood of objective binge episodes (OBEs) than the cisgender groups, albeit lower than youth with EDs. A substantial proportion of TGNC participants scored in elevated ranges on the EDE-Q global score (35% ≥ score of 3, 17% ≥ score of 4), significantly higher than cisgender males (0% ≥ score of 3, 0% ≥ score of 4) and females (9% ≥ score of 3, 3% ≥ score of 4). CONCLUSIONS Findings indicate that TGNC youth exhibit increased ED cognitions and OBEs compared to cisgender samples, highlighting the need for screening and addressing ED symptoms in this population.
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Affiliation(s)
- Isabel C Quiñones
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Ellen Selkie
- University of Wisconsin, Madison, Wisconsin, USA
| | - Kathleen A Mammel
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Alissa Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - S Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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18
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Bowman SJ, Hakeem A, Demant D, McAloon J, Wootton BM. Assessing Gender Dysphoria: Development and Validation of the Gender Preoccupation and Stability Questionnaire - 2 nd Edition (GPSQ-2). JOURNAL OF HOMOSEXUALITY 2024; 71:666-690. [PMID: 36286814 DOI: 10.1080/00918369.2022.2132440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Gender Preoccupation and Stability Questionnaire (GPSQ) is a 14-item measure used to assess the effectiveness of medical, surgical, social, and psychological interventions in trans and gender diverse adults who experience gender dysphoria. One major limitation of the GPSQ is that it was not developed for use with adolescents. This study aims to validate a revised version of the GPSQ, the Gender Preoccupation and Stability Questionnaire-2nd Edition (GPSQ-2) with the aim of adapting the measure to be applicable to individuals aged 13 and above. This research was conducted in three stages: 1) development of the GPSQ-2 to address previously identified issues with validity and comprehensibility of the GPSQ and to increase the applicability of the measure to adolescents; 2) pilot testing, using a purposive sample and semi-structured interviews, to assess the relevance, comprehensibility, and comprehensiveness of the GPSQ-2; and 3) validation using a community sample to assess the psychometric properties of the GPSQ-2. The pilot study was conducted with seven participants (Mage = 28.43, SD = 15.50; age range: 13-59). The GPSQ-2 was found to be easy to understand, relevant to individuals who experienced gender dysphoria, and that it did not have any identifiable omissions. The validation study was conducted with 141 participants (Mage = 36.44; SD = 14.76; age range 14-73). The GPSQ-2 was found to be a reliable and valid 14-item scale with two factors: preoccupation and stability. The GPSQ-2 is a structurally sound measure of gender dysphoria that can be used in populations aged 13 and above.
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Affiliation(s)
- Sarah Joy Bowman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Az Hakeem
- The Priory Hospital Roehampton, London, UK
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - John McAloon
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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19
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Boettcher C, Tittel SR, Reschke F, Fritsch M, Schreiner F, Achenbach M, Thiele-Schmitz S, Gillessen A, Galler A, Nellen-Hellmuth N, Golembowski S, Holl RW. Diabetes and gender incongruence: frequent mental health issues but comparable metabolic control - a DPV registry study. Front Endocrinol (Lausanne) 2024; 14:1240104. [PMID: 38317711 PMCID: PMC10841572 DOI: 10.3389/fendo.2023.1240104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024] Open
Abstract
Context The condition when a person's gender identity does not match the sex assigned at birth is called gender incongruence (GI). Numbers of GI people seeking medical care increased tremendously over the last decade. Diabetes mellitus is a severe and lifelong disease. GI combined with diabetes may potentiate into a burdensome package for affected people. Objective The study aimed to characterize people with GI and diabetes from an extensive standardized registry, the Prospective Diabetes Follow-up Registry (DPV), and to identify potential metabolic and psychological burdens. Methods We compared demographic and clinical registry data of persons with type 1 or type 2 diabetes and GI to those without GI and used propensity score matching (1:4) with age, diabetes duration and treatment year as covariates. Results 75 persons with GI, 49 with type 1 and 26 with type 2 diabetes were identified. HbA1c values were similar in matched persons with type 1 or 2 diabetes and GI compared to those without GI. Lipid profiles showed no difference, neither in type 1 nor in type 2 diabetes. Diastolic blood pressure was higher in the type 1 and GI group than in those without, whereas systolic blood pressure showed comparable results in all groups. Depression and anxiety were significantly higher in GI people (type 1 and 2). Non-suicidal self-injurious behaviour was more common in type 1 and GI, as was suicidality in type 2 with GI. Conclusion Mental health issues are frequent in people with diabetes and GI and need to be specially addressed in this population.
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Affiliation(s)
- Claudia Boettcher
- Paediatric Endocrinology and Diabetology, University of Bern Faculty of Medicine, Bern, Switzerland
| | - Sascha R. Tittel
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Felix Reschke
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Maria Fritsch
- Department of Paediatric and Adolescent Medicine, Division of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Felix Schreiner
- Paediatric Endocrinology Division, Children’s Hospital, University of Bonn, Bonn, Germany
| | - Maike Achenbach
- Department of Gastroenterology and Diabetology, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Susanne Thiele-Schmitz
- Diabetes Centre for Children and Adolescents, St. Louise Women’s and Children’s Hospital, Paderborn, Germany
| | - Anton Gillessen
- Department of Internal Medicine, Herz-Jesu-Hospital, Muenster, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | - Nicole Nellen-Hellmuth
- Centre of Child and Adolescent Medicine, Leopoldina Clinic Schweinfurt, Schweinfurt, Germany
| | - Sven Golembowski
- Department of Paediatrics, Sana Hospital Lichtenberg, Berlin, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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20
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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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21
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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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22
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Castellanos-López I, González-Rodríguez LG, Bermejo LM, Cuadrado-Soto E, López-Sobaler AM. [Nutritional problems in cis and trans women]. NUTR HOSP 2023; 40:33-36. [PMID: 37929906 DOI: 10.20960/nh.04952] [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] [Indexed: 11/07/2023] Open
Abstract
Introduction Women deserve special attention due to the different requirements they have in comparison with men. In the same way, transgender women need individualized attention. Transgender women are at greater risk of suffering heart attacks or ischemic accidents, among other diseases, and are also at greater risk of developing eating disorders, poorer weight control and poorer perception of their image. Hormone therapy for gender reaffirmation in trans women modifies their body composition, and may also increase the risk of suffering from some pathologies. The nutritional needs of cisgender women are different from those of men, and trans women also have special needs, which may depend on whether or not they follow hormone therapy. Dietary studies, although scarce, suggest that transgender women have poor dietary habits and lifestyle. It is necessary to deepen the study of the nutritional situation of the female group, considering its diversity, and to develop standards and references appropriate to each case that allow better attention to the needs of these groups.
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Affiliation(s)
- Isabel Castellanos-López
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid
| | | | - Laura M Bermejo
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030). IdISSC
| | | | - Ana M López-Sobaler
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030). IdISSC
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23
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Eisenstadt BE, Murchison GR, Soulliard ZA, Gordon AR. Body Image and High-Risk Weight and Shape Control Behaviors Among Transgender and Nonbinary Young Adults: The Role of Sexual Assault. LGBT Health 2023; 10:586-594. [PMID: 37410994 PMCID: PMC10712357 DOI: 10.1089/lgbt.2022.0324] [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] [Indexed: 07/08/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) populations experience disproportionate rates of sexual assault. Despite evidence from cisgender samples linking sexual assault exposure to body image concerns and disordered eating behaviors, such as weight and shape control behaviors (WSCBs), little is known about these relationships in TNB people. The purpose of this study was to assess associations among past-year sexual assault exposure, body areas satisfaction, body weight esteem, and high-risk WSCBs in a sample of TNB young adults. Methods: A sample of 714 participants completed a cross-sectional online survey. Multivariable linear and logistic models were fit to determine associations between constructs of interest. Natural effects mediation analyses assessed for potential mediation of the relationship between sexual assault and WSCBs by body areas satisfaction and body weight esteem. Analyses were stratified by three gender identity categories. Results: Past-year sexual assault exposure was associated with significantly decreased body areas satisfaction, but only for nonbinary participants. No significant association was found between sexual assault and body weight esteem. Sexual assault was associated with significantly increased risk for WSCBs across gender identity categories. No mediation of these relationships by body areas satisfaction and body weight esteem was observed. Conclusion: Findings support clinical consideration of WSCBs in TNB survivors of sexual assault. Results suggest that multiple factors, including body image and sexual assault, may contribute separately to disordered eating behaviors in TNB young adults.
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Affiliation(s)
- Benjamin E. Eisenstadt
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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24
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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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25
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Curtis A, Swaringen S, Janssen A. Complex Psychiatric Histories and Transgender and Gender Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:731-745. [PMID: 37739631 DOI: 10.1016/j.chc.2023.05.011] [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: 09/24/2023]
Abstract
Transgender and gender diverse (TGD) individuals face higher rates of stressors driving disproportionate health risks. Although psychiatric conditions are important to consider in the context of greater health-promoting efforts for TGD youth, any mental health concerns may or may not be related to gender identity or associated dysphoria. Nevertheless, it is essential to consider the impact of complex mental health factors on decisional capacity and gender care discussions. Psychiatric care of TGD youth includes stratifying risk factors through a minority stress lens, balancing acute needs with patient and caregiver priorities, and bolstering resilience using affirming care principles.
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Affiliation(s)
- Amy Curtis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - Shanna Swaringen
- Division of Psychiatry and Behavioral Health, The Ohio State University College of Medicine. Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Aron Janssen
- The Pritzker Department of Psychiatry and Behavioral Health, Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario, Chicago, IL 60611, USA. https://twitter.com/LGBTDoc
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26
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Swami V, Tran US, Stieger S, Aavik T, Ranjbar HA, Adebayo SO, Afhami R, Ahmed O, Aimé A, Akel M, Halbusi HA, Alexias G, Ali KF, Alp-Dal N, Alsalhani AB, Álvares-Solas S, Amaral ACS, Andrianto S, Aspden T, Argyrides M, Aruta JJBR, Atkin S, Ayandele O, Baceviciene M, Bahbouh R, Ballesio A, Barron D, Bellard A, Bender SS, Beydağ KD, Birovljević G, Blackburn MÈ, Borja-Alvarez T, Borowiec J, Bozogáňová M, Bratland-Sanda S, Browning MHEM, Brytek-Matera A, Burakova M, Çakır-Koçak Y, Camacho P, Camilleri VE, Cazzato V, Cerea S, Chaiwutikornwanich A, Chaleeraktrakoon T, Chambers T, Chen QW, Chen X, Chien CL, Chobthamkit P, Choompunuch B, Compte EJ, Corrigan J, Cosmas G, Cowden RG, Czepczor-Bernat K, Czub M, da Silva WR, Dadfar M, Dalley SE, Dany L, Datu JAD, Berbert de Carvalho PH, Coelho GLDH, De Jesus AOS, Debbabi SH, Dhakal S, Di Bernardo F, Dimitrova DD, Dion J, Dixson B, Donofrio SM, Drysch M, Du H, Dzhambov AM, El-Jor C, Enea V, Eskin M, Farbod F, Farrugia L, Fian L, Fisher ML, Folwarczny M, Frederick DA, Fuller-Tyszkiewicz M, Furnham A, García AA, Geller S, Ghisi M, Ghorbani A, Martinez MAG, Gradidge S, Graf S, Grano C, Gyene G, Hallit S, Hamdan M, Handelzalts JE, Hanel PHP, Hawks SR, Hekmati I, Helmy M, Hill T, Hina F, Holenweger G, Hřebíčková M, Ijabadeniyi OA, Imam A, İnce B, Irrazabal N, Jankauskiene R, Jiang DY, Jiménez-Borja M, Jiménez-Borja V, Johnson EM, Jovanović V, Jović M, Jović M, Junqueira ACP, Kahle LM, Kantanista A, Karakiraz A, Karkin AN, Kasten E, Khatib S, Khieowan N, Kimong PJ, Kiropoulos L, Knittel J, Kohli N, Koprivnik M, Kospakov A, Król-Zielińska M, Krug I, Kuan G, Kueh YC, Kujan O, Kukić M, Kumar S, Kumar V, Lamba N, Lauri MA, Laus MF, LeBlanc LA, Lee HJ, Lipowska M, Lipowski M, Lombardo C, Lukács A, Maïano C, Malik S, Manjary M, Baldó LM, Martinez-Banfi M, Massar K, Matera C, McAnirlin O, Mebarak MR, Mechri A, Meireles JFF, Mesko N, Mills J, Miyairi M, Modi R, Modrzejewska A, Modrzejewska J, Mulgrew KE, Myers TA, Namatame H, Nassani MZ, Nerini A, Neto F, Neto J, Neves AN, Ng SK, Nithiya D, O J, Obeid S, Oda-Montecinos C, Olapegba PO, Olonisakin TT, Omar SS, Örlygsdóttir B, Özsoy E, Otterbring T, Pahl S, Panasiti MS, Park Y, Patwary MM, Pethö T, Petrova N, Pietschnig J, Pourmahmoud S, Prabhu VG, Poštuvan V, Prokop P, Ramseyer Winter VL, Razmus M, Ru T, Rupar M, Sahlan RN, Hassan MS, Šalov A, Sapkota S, Sarfo JO, Sawamiya Y, Schaefer K, Schulte-Mecklenbeck M, Seekis V, Selvi K, Sharifi M, Shrivastava A, Siddique RF, Sigurdsson V, Silkane V, Šimunić A, Singh G, Slezáčková A, Sundgot-Borgen C, Ten Hoor G, Tevichapong P, Tipandjan A, Todd J, Togas C, Tonini F, Tovar-Castro JC, Trangsrud LKJ, Tripathi P, Tudorel O, Tylka TL, Uyzbayeva A, Vally Z, Vanags E, Vega LD, Vicente-Arruebarrena A, Vidal-Mollón J, Vilar R, Villegas H, Vintilă M, Wallner C, White MP, Whitebridge S, Windhager S, Wong KY, Yau EK, Yamamiya Y, Yeung VWL, Zanetti MC, Zawisza M, Zeeni N, Zvaríková M, Voracek M. Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age. Body Image 2023; 46:449-466. [PMID: 37582318 DOI: 10.1016/j.bodyim.2023.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.
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Affiliation(s)
- Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom; Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia.
| | - Ulrich S Tran
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Stefan Stieger
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Toivo Aavik
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | | | | | - Reza Afhami
- Department of Art Studies, Tarbiat Modares University, Tehran, Iran
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, Bangladesh
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Saint-Jérôme, Canada
| | - Marwan Akel
- INSPECT-LB: National Institute of Public Health, Clinical Epidemiology, and Toxicology, Beirut, Lebanon; School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hussam Al Halbusi
- Department of Management, Ahmed Bin Mohammad Military College, Doha, Qatar
| | - George Alexias
- Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Khawla F Ali
- Royal College of Surgeons Ireland-Bahrain, Adliya, Bahrain
| | - Nursel Alp-Dal
- Department of Midwifery, Faculty of Health Sciences, Munzur University, Tunceli, Turkiya
| | - Anas B Alsalhani
- Department of Oral Medicine and Diagnostic Sciences, Vision College of Dentistry and Nursing, Vision Colleges, Riyadh, Saudi Arabia
| | - Sara Álvares-Solas
- Facultad de Ciencias de la Vida, Universidad Regional Amazónica Ikiam, Muyuna, Ecuador
| | | | - Sonny Andrianto
- Department of Psychology, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Trefor Aspden
- Department of Psychology, Aberystwyth University, Ceredigion, United Kingdom
| | - Marios Argyrides
- Department of Psychology, Neapolis University Pafos, Paphos, Cyprus
| | | | - Stephen Atkin
- Royal College of Surgeons Ireland-Bahrain, Adliya, Bahrain
| | - Olusola Ayandele
- Department of General Studies, The Polytechnic, Ibadan, Nigeria; Department of Psychology, University of Ibadan, Ibadan, Nigeria
| | - Migle Baceviciene
- Health Research and Innovation Science Centre, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Radvan Bahbouh
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - David Barron
- School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Ashleigh Bellard
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | | | - Kerime Derya Beydağ
- Department of Nursing, Faculty of Health Sciences, Istanbul Gedik University, Istanbul, Turkiye
| | - Gorana Birovljević
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
| | | | - Teresita Borja-Alvarez
- Colegio de Ciencias Sociales y Humanidades, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Joanna Borowiec
- Department of Physical Education and Lifelong Sports, Poznań University of Physical Education, Poznań, Poland
| | - Miroslava Bozogáňová
- Institute of Social Sciences of the Centre of Social and Psychological Sciences, Košice, Slovakia; Faculty of Humanities and Natural Sciences, Institute of Pedagogy, Andragogy, and Psychology, University of Prešov, Prešov, Slovakia
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, Bø, Telemark, Norway
| | - Matthew H E M Browning
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, United States of America
| | | | - Marina Burakova
- Laboratory of Social Psychology, Aix-Marseille University, Aix-en-Provence, France
| | - Yeliz Çakır-Koçak
- Department of Midwifery, Faculty of Health Sciences, Bartın University, Bartın, Turkiye
| | | | | | - Valentina Cazzato
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy; Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | - Trawin Chaleeraktrakoon
- Department of Psychology, Faculty of Liberal Arts, Thammasat University, Pathumthani, Thailand
| | - Tim Chambers
- School of Psychology, Deakin University, Geelong, Australia
| | - Qing-Wei Chen
- Lab of Light and Physio-Psychological Health, National Center for International Research on Green Optoelectrics, South China Normal University, Guangzhou, China; Guangdong Provincial Key Laboratory of Optical Information Materials and Technology & Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou, China
| | - Xin Chen
- Department of Psychology, Graduate School of Arts and Science, New York University, New York, United States of America
| | - Chin-Lung Chien
- Department of Psychology, Soochow University, Taipei, Taiwan
| | | | - Bovornpot Choompunuch
- Department of Educational Psychology and Guidance, Faculty of Education, Mahasarakham University, Maha Sarakham, Thailand
| | - Emilio J Compte
- School of Psychology, Universidad Adolfo Ibáñez, Penalolen, Chile; Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Jennifer Corrigan
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Getrude Cosmas
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Richard G Cowden
- Human Flourishing Program, Harvard University, Cambridge, United States of America
| | - Kamila Czepczor-Bernat
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marcin Czub
- Institute of Psychology, University of Wrocław, Wrocław, Poland
| | - Wanderson Roberto da Silva
- Graduate Program in Food, Nutrition, and Food Engineering, São Paulo State University, São Paulo, Brazil
| | - Mahboubeh Dadfar
- Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Simon E Dalley
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Lionel Dany
- Laboratory of Social Psychology, Aix-Marseille University, Aix-en-Provence, France
| | - Jesus Alfonso D Datu
- Teacher Education and Learning Leadership Academic Unit, Faculty of Education. The University of Hong Kong, Hong Kong, China
| | - Pedro Henrique Berbert de Carvalho
- Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, Juiz de Fora, Brazil; Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Sandesh Dhakal
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | | | - Donka D Dimitrova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacinthe Dion
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Barnaby Dixson
- School of Health, University of the Sunshine Coast, Moreton Bay, Australia
| | - Stacey M Donofrio
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Marius Drysch
- Department of Plastic and Hand Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Hongfei Du
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Claire El-Jor
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Violeta Enea
- Department of Psychology, Alexandru Ioan Cuza University, Iași, Romania
| | - Mehmet Eskin
- Department of Psychology, Koc University, Istanbul, Turkiye
| | - Farinaz Farbod
- Department of Textile and Fashion Design, Alzahra University, Tehran, Iran
| | | | - Leonie Fian
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Michał Folwarczny
- Discipline of Marketing, J.E. Cairnes School of Business & Economics, University of Galway, Galway, Ireland
| | - David A Frederick
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, United States of America
| | | | - Adrian Furnham
- Department of Leadership and Organizational Behaviour, Norwegian Business School, Oslo, Norway
| | | | - Shulamit Geller
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy; Unità Operativa Complessa (UOC) Hospital Psychology, Padova University Hospital, Padova, Italy
| | - Alireza Ghorbani
- Department of Social Sciences, Payam Noor University, Tehran, Iran
| | | | - Sarah Gradidge
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Sylvie Graf
- Institute of Psychology, Czech Academy of Sciences, Prague, Czechia
| | - Caterina Grano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Gyöngyvér Gyene
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon; Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
| | - Motasem Hamdan
- Faculty of Public Health, Al-Quds University, East Jerusalem, Palestine
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel; Department of Psychiatry, University of Michigan, Ann Arbor, United States of America
| | - Paul H P Hanel
- Department of Psychology, University of Essex, Colchester, United Kingdom
| | - Steven R Hawks
- Department of Kinesiology and Health Science, Utah State University, Logan, UnitedStates of America
| | - Issa Hekmati
- Department of Psychology, Faculty of Human Science, University of Maragheh, Maragheh, Iran
| | - Mai Helmy
- Department of Psychology, College of Education, Sultan Qaboos University, Muscat, Oman; Department of Psychology, Faculty of Arts, Menoufia University, Shebin el Kom, Egypt
| | - Tetiana Hill
- Hertfordshire Business School, University of Hertfordshire, Hatfield, United Kingdom
| | - Farah Hina
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | - Asma Imam
- Faculty of Public Health, Al-Quds University, East Jerusalem, Palestine
| | - Başak İnce
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Natalia Irrazabal
- Faculty of Social Sciences, University of Palermo, Buenos Aires, Argentina
| | - Rasa Jankauskiene
- Health Research and Innovation Science Centre, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Ding-Yu Jiang
- Department of Psychology, National Chung Cheng University, Chia Yi, Taiwan
| | - Micaela Jiménez-Borja
- Colegio de Ciencias Sociales y Humanidades, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Verónica Jiménez-Borja
- Colegio de Comunicación y Artes Contemporáneas, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Evan M Johnson
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, United States of America
| | - Veljko Jovanović
- Department of Psychology, University of Novi Sad, Novi Sad, Serbia
| | - Marija Jović
- Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Marko Jović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Alessandra Costa Pereira Junqueira
- Department of Psychology, University of São Paulo, Ribeirão Preto, Brazil; Department of Nutrition, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Lisa-Marie Kahle
- Faculty of Life Sciences, Medical School Hamburg, Hamburg, Germany
| | - Adam Kantanista
- Department of Physical Education and Lifelong Sports, Poznań University of Physical Education, Poznań, Poland
| | - Ahmet Karakiraz
- Sakarya Business School, Sakarya University, Sakarya, Turkiye
| | | | - Erich Kasten
- Faculty of Life Sciences, Medical School Hamburg, Hamburg, Germany
| | - Salam Khatib
- Faculty of Health Professions, Al-Quds University, East Jerusalem, Palestine
| | - Nuannut Khieowan
- Asian Studies Department, Faculty of International Studies, Prince of Songkla University Phuket Campus, Phuket, Thailand
| | | | - Litza Kiropoulos
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Joshua Knittel
- Department of Consumer Behavior, University of Bern, Bern, Switzerland
| | - Neena Kohli
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Mirjam Koprivnik
- Institute of Anton Martin Slomsek, Primary School Montessori, Maribor, Slovenia
| | - Aituar Kospakov
- Department of Sociology and Social Work, Al-Farabi Kazakh National University, Almaty, Kazakhstan; Department of General Education Disciplines, Astana IT University, Astana, Kazakhstan
| | - Magdalena Król-Zielińska
- Department of Physical Education and Lifelong Sports, Poznań University of Physical Education, Poznań, Poland
| | - Isabel Krug
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Garry Kuan
- Exercise and Sport Sciences, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Yee Cheng Kueh
- Biostatics and Research Methods Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Omar Kujan
- Oral Diagnostics and Surgical Sciences, UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Miljana Kukić
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Sanjay Kumar
- Department of Psychology, D.A.V. College, Muzaffarnagar, India
| | - Vipul Kumar
- Department of Psychology, Kashi Naresh Government Post-Graduate College, Gyanpur, India
| | - Nishtha Lamba
- Department of Psychology, Middlesex University Dubai, Dubai, United Arab Emirates
| | | | - Maria Fernanda Laus
- Department of Psychology, University of São Paulo, Ribeirão Preto, Brazil; Department of Nutrition, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Hyejoo J Lee
- Department of Counselling Psychology and Social Welfare, Handong Global University, Pohang, South Korea
| | | | - Mariusz Lipowski
- Faculty of Social and Humanities, University WSB Merito, Gdansk, Poland
| | | | - Andrea Lukács
- Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | - Christophe Maïano
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Saint-Jérôme, Canada; Cyberpsychology Laboratory, Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada
| | - Sadia Malik
- Department of Psychology, University of Sargodha, Sargodha, Pakistan
| | - Mandar Manjary
- Department of Psychology, D.A.V. College, Muzaffarnagar, India; M.M.D. Public School, Brahmpuri, Muzaffarnagar, India
| | - Lidia Márquez Baldó
- Department of Research Methods and Diagnosis in Education, University of València, València, Spain
| | - Martha Martinez-Banfi
- Faculty of Legal and Social Sciences, Simón Bolívar University, Barranquilla, Colombia; Life Science Research Centre, Simón Bolívar University, Barranquilla, Colombia
| | - Karlijn Massar
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Camila Matera
- Department of Education, Languages, Intercultures, Literatures, and Psychology, University of Florence, Florence, Italy
| | - Olivia McAnirlin
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, United States of America
| | | | - Anwar Mechri
- Faculty of Medicine of Monastir, Eya Medical Centre, Monastir, Tunisia
| | | | - Norbert Mesko
- Institute of Psychology, University of Pécs, Pécs, Hungary
| | | | - Maya Miyairi
- Department of Health Sciences, DePaul University, Chicago, United States of America
| | - Ritu Modi
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Adriana Modrzejewska
- Department of Psychology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Kate E Mulgrew
- School of Health, University of the Sunshine Coast, Moreton Bay, Australia
| | - Taryn A Myers
- Department of Psychology, Virginia Wesleyan University, Virginia Beach, United States of America
| | - Hikari Namatame
- Faculty of Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Mohammad Zakaria Nassani
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Amanda Nerini
- Department of Education, Languages, Intercultures, Literatures, and Psychology, University of Florence, Florence, Italy
| | - Félix Neto
- Department of Psychology, University of Porto, Porto, Portugal
| | - Joana Neto
- Research Center in Business Sciences and Tourism of Consuelo Vieira da Costa Foundation (CICET-FCVC), Porto, Portugal
| | - Angela Noguiera Neves
- Division of Research, Physical Education College of the Brazilian Army, Rio de Janeiro, Brazil
| | - Siu-Kuen Ng
- Physical Education Unit, Chinese University of Hong Kong, Hong Kong, China
| | - Devi Nithiya
- Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Jiaqing O
- Department of Psychology, Aberystwyth University, Ceredigion, United Kingdom
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | | | | | | | - Salma Samir Omar
- Department of Dermatology, Venereology, and Andrology, Alexandria University, Alexandria, Egypt
| | | | - Emrah Özsoy
- Sakarya Business School, Sakarya University, Sakarya, Turkiye
| | | | - Sabine Pahl
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Maria Serena Panasiti
- Santa Lucia Foundation, Scientific Institute for Research and Healthcare, Rome, Italy
| | - Yonguk Park
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Tatiana Pethö
- Department of Managerial Psychology, The University of Presov, Presov, Slovakia
| | - Nadezhda Petrova
- Department of Human Anatomy, Histology and Embryology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jakob Pietschnig
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | | | - Vita Poštuvan
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia; Department of Psychology FAMNIT, University of Primorska, Koper, Slovenia
| | - Pavol Prokop
- Department of Environmental Ecology and Landscape Management, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia; Institute of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Magdalena Razmus
- Institute of Psychology, Marie Curie-Skłodowska University, Lublin, Poland
| | - Taotao Ru
- Lab of Light and Physio-Psychological Health, National Center for International Research on Green Optoelectrics, South China Normal University, Guangzhou, China; Guangdong Provincial Key Laboratory of Optical Information Materials and Technology & Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou, China
| | - Mirjana Rupar
- Institute of Psychology, Czech Academy of Sciences, Prague, Czechia; Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Reza N Sahlan
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo-SUNY, Buffalo, United States of America
| | | | - Anđela Šalov
- Department of Psychology, University of Zadar, Zadar, Croatia
| | - Saphal Sapkota
- KOSHISH-National Mental Health Self-Help Organization, Kusunti, Lalitpur, Nepal
| | - Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Yoko Sawamiya
- Faculty of Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Katrin Schaefer
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria; Human Evolution and Archaeological Sciences, University of Vienna, Vienna, Austria
| | - Michael Schulte-Mecklenbeck
- Department of Consumer Behavior, University of Bern, Bern, Switzerland; Max Planck Institute for Human Development, Berlin, Germany
| | - Veya Seekis
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Kerim Selvi
- Department of Psychology, Eskişehir Osmangazi University, Eskişehir, Turkiye
| | - Mehdi Sharifi
- Department of Psychology, Islamic Azad University, Bandar Gaz, Iran
| | - Anita Shrivastava
- Department of Psychology, Middlesex University Dubai, Dubai, United Arab Emirates
| | | | - Valdimar Sigurdsson
- Department of Business Administration, Reykjavik University, Reykjavik, Iceland
| | - Vineta Silkane
- Faculty of Social Sciences, Vidzeme University of Applied Sciences, Valmiera, Latvia
| | - Ana Šimunić
- Department of Psychology, University of Zadar, Zadar, Croatia
| | - Govind Singh
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Alena Slezáčková
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Gill Ten Hoor
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Passagorn Tevichapong
- Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai, Thailand
| | - Arun Tipandjan
- International Centre for Psychological Counselling and Social Research, Puducherry, India
| | - Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom; Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Constantinos Togas
- Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Fernando Tonini
- Faculty of Social Sciences, University of Palermo, Buenos Aires, Argentina
| | | | - Lise Katrine Jepsen Trangsrud
- Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, Bø, Telemark, Norway
| | - Pankaj Tripathi
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Otilia Tudorel
- Department of Psychology, West University of Timişoara, Timişoara, Romania
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, Columbus, United States of America
| | - Anar Uyzbayeva
- Department of General Education Disciplines, Astana IT University, Astana, Kazakhstan
| | - Zahir Vally
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Edmunds Vanags
- Faculty of Education, Psychology, and Art, University of Latvia, Rīga, Latvia
| | - Luis Diego Vega
- Vice-rectory for Teaching, Research, and Extension, Universida Latina de Costa Rica, San José, Costa Rica
| | | | - Jose Vidal-Mollón
- Department of Research Methods and Diagnosis in Education, University of València, València, Spain
| | - Roosevelt Vilar
- Department of Psychology, Massey University, Auckland, New Zealand
| | - Hyxia Villegas
- Vice-rectory for Teaching, Research, and Extension, Universida Latina de Costa Rica, San José, Costa Rica
| | - Mona Vintilă
- Department of Psychology, West University of Timişoara, Timişoara, Romania
| | - Christoph Wallner
- Department of Plastic and Hand Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Mathew P White
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Sonja Windhager
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria; Human Evolution and Archaeological Sciences, University of Vienna, Vienna, Austria
| | - Kah Yan Wong
- School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Eric Kenson Yau
- Department of Psychology, Lingnan University, Hong Kong, China
| | - Yuko Yamamiya
- Department of Undergraduate Studies, Temple University, Japan Campus, Tokyo, Japan
| | - Victoria Wai Lan Yeung
- Department of Psychology, Lingnan University, Hong Kong, China; Wofoo Joseph Lee Consulting and Counselling Psychology Research Centre, Lingnan University, Hong Kong, China
| | | | - Magdalena Zawisza
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Nadine Zeeni
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Martina Zvaríková
- Department of Environmental Ecology and Landscape Management, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Martin Voracek
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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Pham AH, Eadeh HM, Garrison MM, Ahrens KR. A Longitudinal Study on Disordered Eating in Transgender and Nonbinary Adolescents. Acad Pediatr 2023; 23:1247-1251. [PMID: 36587733 DOI: 10.1016/j.acap.2022.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We longitudinally explored frequency of disordered eating among transgender and nonbinary (TGNB) adolescents and explored trends by gender identity and gender-affirming care. METHODS Participants completed an abbreviated version of the Eating Disorder Examination Questionnaire (EDE-Q) at baseline, 3, 6, and 12 months after establishing care in a gender clinic. We analyzed descriptive statistics and multivariate linear regression analyses. RESULTS Of the 91 TGNB adolescent participants, 61% were transmasculine, 30% transfeminine, and 7% nonbinary/gender-fluid. Among TGNB adolescents, disordered eating thoughts/behaviors were frequently endorsed with 26% of participants engaging in any occurrence of binge eating, 27% limiting the amount of food they ate, and 30% excluding foods from their diet. Forty percent of participants reported any occurrence of at least 1 disordered eating behavior and 17% at least 3 behaviors. Abbreviated EDE-Q responses did not differ significantly by sex assigned at birth, gender identity, gender-affirming medications, or time spent receiving gender-affirming care. There was a significant effect of age (P value = .003) on abbreviated EDE-Q scores. CONCLUSIONS There were no significant changes in disordered eating after initiating gender-affirming medical care, possibly due to the limited study time frame of 12 months. Given the high prevalence of disordered eating behaviors, clinicians should consider screening all TGNB adolescents for disordered eating thoughts/behaviors throughout gender-affirming care. Future longitudinal research should recruit larger samples with a diverse range of gender identities and survey disordered eating thoughts/behaviors at least one year after starting gender-affirming medications.
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Affiliation(s)
- An H Pham
- Division of Adolescent Medicine, Seattle Children's Hospital (AH Pham and KR Ahrens), Seattle, Wash.
| | - Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa (H-M Eadeh), Iowa City, Iowa
| | - Michelle M Garrison
- Seattle Children's Research Institute (MM Garrison and KR Ahrens), Seattle, Wash
| | - Kym R Ahrens
- Division of Adolescent Medicine, Seattle Children's Hospital (AH Pham and KR Ahrens), Seattle, Wash; Seattle Children's Research Institute (MM Garrison and KR Ahrens), Seattle, Wash
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Gunaydin D, Burchell D, Hickens N, Joy P. Not Just Checklists and Rainbows: Exploring Canadian Dietitians' Beliefs, Values, and Knowledge of Transgender Nutritional Care. Transgend Health 2023; 8:381-388. [PMID: 37525835 PMCID: PMC10387146 DOI: 10.1089/trgh.2021.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose Many transgender (short form: trans) people are experiencing disparities within Canadian health care systems, including nutritional and dietetic health care systems. This research explores the views, beliefs, and experiences of Canadian dietitians about trans nutritional care and seeks to understand how dietitians can better address the nutritional needs of trans individuals. Methods Semistructured online interviews were conducted with 16 Canadian dietitians. Interviews were transcribed and the data were analyzed thematically. Results Three main themes were created; (1) There's an Unjust System, (2) We've Come a Long Way, and (3) Not Just Checklists and Rainbows. The participants explored the historic nature of the Canadian dietetic profession and noted the connection between cis-normativity and the erasure of trans identities. They also explored how dietitians could better address the health needs of trans people, including moving beyond the acknowledgement of trans identities to changing the way gender is viewed in the profession. Conclusion The dietetic profession must move beyond surface-level activities and rethink gender. Recommendations include adding trans-focused care training into the profession, creating safer spaces for trans individuals, advocacy and allyship, and recruiting trans people to the profession.
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Affiliation(s)
- Duygu Gunaydin
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Drew Burchell
- Department of Biology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Nicholas Hickens
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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29
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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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30
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Filipov H, Kavla Y, Şahin S, Gökler ME, Turan Ş. The Effects of Gender-Affirming Hormone Therapy on Body Satisfaction, Self-Esteem, Quality of Life, and Psychopathology in People with Female-to-Male Gender Dysphoria. Transgend Health 2023; 8:168-174. [PMID: 37013091 PMCID: PMC10066770 DOI: 10.1089/trgh.2021.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Gender-affirming hormone therapy (GAHT) is one of the most important therapeutic interventions sought by people with gender dysphoria (GD). In the present study, we aimed to examine the effects of GAHT on body satisfaction, self-esteem, quality of life, and psychopathology in people with female-to-male (FtM) GD. Methods Thirty-seven FtM GD participants who did not receive any gender-affirming therapy, 35 FtM GD participants who received GAHT for over 6 months, and 38 cisgender women were included in the study. The Body Cathexis Scale (BCS), Rosenberg Self Esteem Scale (RSES), World Health Organization's Quality of Life Questionnaire Brief Form (WHOQOL-BREF), and Symptom Checklist-90-Revised (SCL-90-R) were completed by all participants. Results The BCS scores of the untreated group were significantly lower than both the GAHT group and the female controls (p<0.001); while the WHOQOL-BREF-psychological health scores of the untreated group were significantly lower than those of the female controls (p=0.003). The psychoticism subscale scores on the SCL-90-R of the untreated group were higher than those of the GAHT group (p=0.04) as well as the female controls (p=0.003). With regard to the RSES, there were no significant differences between the groups. Conclusion Our findings suggest that people with FtM GD who receive GAHT are more satisfied with their bodies and have less psychopathological problems compared to those who do not receive GAHT, but their quality of life and self-esteem do not change as a result of GAHT.
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Affiliation(s)
- Hülya Filipov
- Department of Psychology, Dogus University, Istanbul, Turkey
| | - Yasin Kavla
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Fatih, Turkey
| | - Serdar Şahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Fatih, Turkey
| | - Mehmet Enes Gökler
- Department of Public Health, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Fatih, Turkey
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Pham A, Kerman H, Albertson K, Crouch JM, Inwards-Breland DJ, Ahrens KR. Understanding the Complex Relationship Between One's Body, Eating, Exercise, and Gender-Affirming Medical Care Among Transgender and Nonbinary Adolescents and Young Adults. Transgend Health 2023; 8:149-158. [PMID: 37013089 PMCID: PMC10066775 DOI: 10.1089/trgh.2021.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Gender dysphoria has been linked to body dissatisfaction, which can affect an individual's eating and exercise habits and increase their risk for disordered eating. The prevalence of eating disorders among transgender and nonbinary (TGNB) adolescents and young adults (AYA) ranges from 5% to 18% and studies have found a higher risk of disordered eating among these AYA in comparison to their cisgender peers. However, there is minimal research on why TGNB AYA are at higher risk. The aim of this study is to understand unique factors that define a TGNB AYA's relationship between their body and food, how this relationship may be affected by gender-affirming medical care, and how these relationships may contribute to disordered eating. Methods A total of 23 TGNB AYA were recruited from a multidisciplinary gender-affirming clinic to participate in semistructured interviews. Transcripts were analyzed using Braun and Clarke's theory of thematic analysis (2006). Results The average age of participants was 16.9 years. Forty-four percent of participants identified as having a transfeminine gender identity, 39% transmasculine, and 17% nonbinary/gender fluid. Five themes emerged regarding TGNB participants' relationship to food and exercise: gender dysphoria and control over one's body, societal expectations of gender, mental health and safety concerns, emotional and physical changes with gender-affirming medical care, and recommended resources for TGNB AYA. Conclusion By understanding these unique factors, clinicians can provide targeted and sensitive care when screening and managing disordered eating among TGNB AYA.
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Affiliation(s)
- An Pham
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hannah Kerman
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Katie Albertson
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Julia M. Crouch
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - David J. Inwards-Breland
- Division of Adolescent and Young Adult Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Kym R. Ahrens
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
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Barnhart WR, Cui S, Cui T, Hong D, He J. Transgender congruence, body appreciation, body dissatisfaction, and disordered eating in Chinese transgender adults. Int J Eat Disord 2023. [PMID: 36918351 DOI: 10.1002/eat.23932] [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: 09/13/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Ample evidence shows that transgender congruence is negatively associated with body dissatisfaction and disordered eating in the Western context; however, limited research has explored these relationships in non-Western populations (e.g., Chinese transgender adults). Moreover, to our knowledge, there has been no research describing disordered eating in Chinese transgender adults. Thus, this study aimed to explore group differences in and relationships between transgender congruence, body appreciation, body dissatisfaction, and disordered eating in Chinese transgender adults. METHODS This study examined transgender congruence, body appreciation, body dissatisfaction, and disordered eating in a sample of Chinese transgender adults (N = 200). Chi-square, F tests, and correlation analyses were conducted to examine group differences and relationships between study variables. RESULTS Of the transgender adults, 31.0% screened positive as probable eating disorder (ED) cases. There were no gender identity differences in the study variables. Transgender congruence was positively associated body appreciation (r = .40, p < .001) and negatively associated with body dissatisfaction (r = -.26, p < .001) and disordered eating (r = -.15, p = .031). DISCUSSION Chinese transgender adults may be at high risk of EDs. Transgender congruence and body appreciation may serve a protective role in the context of eating pathology in Chinese transgender adults. Future research is needed to validate the observed relationships between transgender congruence, body appreciation, body dissatisfaction, and disordered eating in Chinese transgender adults. PUBLIC SIGNIFICANCE Research on disordered eating and body image in Chinese transgender adults is limited. This study describes disordered eating and its relations with transgender congruence, body appreciation, and body dissatisfaction in Chinese transgender adults. Findings highlight the need for and implications of ED intervention in Chinese transgender adults.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Macau, China
| | - Dinan Hong
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
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Castellini G, Rossi E, Cassioli E, Sanfilippo G, Ristori J, Vignozzi L, Maggi M, Ricca V, Fisher AD. Internalized transphobia predicts worse longitudinal trend of body uneasiness in transgender persons treated with gender affirming hormone therapy: a 1-year follow-up study. J Sex Med 2023; 20:388-397. [PMID: 36763949 DOI: 10.1093/jsxmed/qdac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Given the relationship between interiorized stigma and body image, it could be hypothesized that high levels of internalized transphobia (IT) might predict higher levels of body uneasiness in subjects with gender dysphoria (GD) and worse improvement of body image after gender affirming hormone therapy (GAHT). AIM We sought to evaluate the relationship between IT and body uneasiness in subjects with GD and the role of IT in moderating the improvement of body image after GAHT. METHODS In total, 200 individuals with GD performed the baseline assessment; 99 were re-evaluated 12 months after starting GAHT. At baseline participants were evaluated through a face-to-face interview and filled self-administered questionnaires to evaluate GD (Utrecht Gender Dysphoria Scale [UGDS]), IT attitudes (Attitudes Toward Transgendered Individuals [ATTI] Scale), body uneasiness (Body Uneasiness Test, part A [BUT-A]), and general psychopathology (Symptom Checklist 90-Revised [SCL 90-R]). The same questionnaires, except ATTI, were readministered at follow-ups. OUTCOMES Outcomes were based on measures of the associations between IT and baseline characteristics of the sample, the longitudinal trends of GD, body uneasiness, and general psychopathology; and IT as a moderator of the longitudinal trend of body uneasiness. RESULTS At baseline, IT correlated with lower level of education, higher GD, and more severe body uneasiness. Longitudinal analyses showed significant improvements in GD, body uneasiness, and general psychopathology during GAHT. Moderation analysis confirmed that participants with more transphobic attitudes showed less improvement after GAHT with regard to body uneasiness (bTime*ATTI = -.002, P = .040). The Johnson-Neyman technique revealed that no significant improvement in body uneasiness was found for participants with ATTI scores lower than 71.14. CLINICAL IMPLICATIONS The presence of IT should be investigated in subjects with GD who require gender affirming treatments to provide specific interventions aimed at targeting this dimension. STRENGTHS AND LIMITATIONS Strengths of this study include the mixed cross-sectional and longitudinal design and the dimensional evaluation of the investigated constructs. Limitations include the small sample size and the limited follow-up. Furthermore, the effects of gender affirming surgery were not evaluated. CONCLUSION The association of IT with both baseline body uneasinessand the longitudinal course of this dimension highlighted the clinical significance of body uneasiness and the importance of making continuous efforts to improve education and information to fight societal stigmas.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulia Sanfilippo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
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Bucher ML, Anderson FL, Lai Y, Dicent J, Miller GW, Zota AR. Exposomics as a tool to investigate differences in health and disease by sex and gender. EXPOSOME 2023; 3:osad003. [PMID: 37122372 PMCID: PMC10125831 DOI: 10.1093/exposome/osad003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023]
Abstract
The health and disease of an individual is mediated by their genetics, a lifetime of environmental exposures, and interactions between the two. Genetic or biological sex, including chromosome composition and hormone expression, may influence both the types and frequency of environmental exposures an individual experiences, as well as the biological responses an individual has to those exposures. Gender identity, which can be associated with social behaviors such as expressions of self, may also mediate the types and frequency of exposures an individual experiences. Recent advances in exposome-level analysis have progressed our understanding of how environmental factors affect health outcomes; however, the relationship between environmental exposures and sex- and gender-specific health remains underexplored. The comprehensive, non-targeted, and unbiased nature of exposomic research provides a unique opportunity to systematically evaluate how environmental exposures interact with biological sex and gender identity to influence health. In this forward-looking narrative review, we provide examples of how biological sex and gender identity influence environmental exposures, discuss how environmental factors may interact with biological processes, and highlight how an intersectional approach to exposomics can provide critical insights for sex- and gender-specific health sciences.
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Affiliation(s)
| | - Faith L Anderson
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Yunjia Lai
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Jocelyn Dicent
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Gary W Miller
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Ami R Zota
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, USA
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Iwamoto SJ, Defreyne J, Kaoutzanis C, Davies RD, Moreau KL, Rothman MS. Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults. Ther Adv Endocrinol Metab 2023; 14:20420188231166494. [PMID: 37113210 PMCID: PMC10126651 DOI: 10.1177/20420188231166494] [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: 07/17/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
As the transgender and gender diverse (TGD) population ages, more transfeminine and transmasculine individuals present to clinic to initiate or continue their gender-affirming care at older ages. Currently available guidelines on gender-affirming care are excellent resources for the provision of gender-affirming hormone therapy (GAHT), primary care, surgery, and mental health care but are limited in their scope as to whether recommendations require tailoring to older TGD adults. Data that inform guideline-recommended management considerations, while informative and increasingly evidence-based, mainly come from studies of younger TGD populations. Whether results from these studies, and therefore recommendations, can or should be extrapolated to aging TGD adults remains to be determined. In this perspective review, we acknowledge the lack of data in older TGD adults and discuss considerations for evaluating cardiovascular disease, hormone-sensitive cancers, bone health and cognitive health, gender-affirming surgery, and mental health in the older TGD population on GAHT.
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Affiliation(s)
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Robert D. Davies
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- CUMedicine LGBTQ Mental Health Clinic, University of Colorado Hospital, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
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36
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Chaphekar AV, Vance SR, Garber AK, Buckelew S, Ganson KT, Downey A, Nagata JM. Transgender and other gender diverse adolescents with eating disorders requiring medical stabilization. J Eat Disord 2022; 10:199. [PMID: 36564815 PMCID: PMC9789657 DOI: 10.1186/s40337-022-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the high prevalence of eating disorders in gender diverse adolescents, little is known about the characteristics of gender diverse youth with eating disorders who require inpatient medical stabilization. The primary objective of this study was to describe the medical, anthropometric, and psychiatric characteristics of gender diverse adolescents hospitalized for eating disorders and compare these characteristics to cisgender peers hospitalized for eating disorders. The secondary objective was to evaluate percent median body mass index as one marker of malnutrition and treatment goal body mass index as a recovery metric between patients' birth-assigned sex and affirmed gender using standardized clinical growth charts. METHODS A retrospective chart review was conducted of 463 patients admitted to an inpatient eating disorders medical unit between 2012 and 2020. To compare medical, anthropometric, and psychiatric data between gender diverse and cisgender patients, chi-square/Fisher's exact and t-tests were used. Clinical growth charts matching the patients' birth-assigned sex and affirmed gender identity were used to assess percent of median body mass index and treatment goal body mass index. RESULTS Ten patients (2.2%) identified as gender diverse and were younger than cisgender patients [13.6 (1.5) years vs. 15.6 (2.7) years, p = 0.017]. Gender diverse patients were hospitalized with a higher percent median body mass index compared to cisgender peers [97.1% (14.8) vs. 87.9% (13.7), p = 0.037], yet demonstrated equally severe vital sign instability such as bradycardia [44 (8.8) beats per minute vs. 46 (10.6) beats per minute, p = 0.501], systolic hypotension [84 (7.1) mmHg vs. 84 (9.7) mmHg, p = 0.995], and diastolic hypotension [46 (5.8) mmHg vs. 45 (7.3) mmHg, p = 0.884]. Gender diverse patients had a higher prevalence of reported anxiety symptoms compared to cisgender patients (60% vs. 28%, p = 0.037). CONCLUSIONS Gender diverse patients demonstrated complications of malnutrition including vital sign instability despite presenting with a higher weight. This is consistent with a greater proportion of gender diverse patients diagnosed with atypical anorexia nervosa compared to cisgender peers. Additionally, psychiatric comorbidities were present among both groups, with a larger percentage of gender diverse patients endorsing anxiety compared to cisgender patients.
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Affiliation(s)
- Anita V Chaphekar
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA.
| | - Stanley R Vance
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Sara Buckelew
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, Canada
| | - Amanda Downey
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0503, San Francisco, CA, 94143, USA
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Nowicki GP, Marchwinski BR, O'Flynn JL, Griffths S, Rodgers RF. Body image and associated factors among sexual minority men: A systematic review. Body Image 2022; 43:154-169. [PMID: 36150358 DOI: 10.1016/j.bodyim.2022.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.
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Affiliation(s)
- Genevieve P Nowicki
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Simmons University, Boston, USA
| | - Breana R Marchwinski
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Simmons University, Boston, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, USA
| | - Jennifer L O'Flynn
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Scott Griffths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France
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38
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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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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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Tebbe EA, Budge SL. Factors that drive mental health disparities and promote well-being in transgender and nonbinary people. NATURE REVIEWS PSYCHOLOGY 2022; 1:694-707. [PMID: 36187743 PMCID: PMC9513020 DOI: 10.1038/s44159-022-00109-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/09/2023]
Abstract
Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions.
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Affiliation(s)
- Elliot A. Tebbe
- School of Nursing, University of Wisconsin-Madison, Madison, WI USA
| | - Stephanie L. Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI USA
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Gender stereotyping and body image of transgender women. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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42
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Muratore LA, Flentje A, Schuster D, Capriotti MR. Disordered Eating and Body Dissatisfaction in Transgender and Gender-Expansive Adults: An Evaluation and Integration of the Gender Minority Stress and Resilience and Tripartite Influence Models. Behav Ther 2022; 53:869-886. [PMID: 35987545 DOI: 10.1016/j.beth.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/02/2022]
Abstract
Transgender and gender-expansive (TGE) people, including transgender and nonbinary individuals, experience elevated rates of body dissatisfaction and disordered eating compared to cisgender individuals, but little is known about why. To address this research gap, we compared the ability of TGE-specific factors as proposed in the gender minority stress and resilience (GMSR) model, general psychological factors contained in the tripartite influence (TI) model, and an integration of these frameworks to explain body dissatisfaction and disordered eating among TGE individuals. Regression analyses were conducted to test the models' abilities to explain experiences reported in a survey of 93 U.S. TGE adults, including 43 transgender women respondents (46.2%) and 31 transgender men respondents (33.3%). Participants were diverse with regard to age (M = 34.19, SD = 12.02) and ethnoracial background (e.g., 29.0% Hispanic/Latinx, 17.2% Black/African American, 6.5% American Indian/Alaska Native; 5.4% multiracial). Results demonstrated both models' abilities to explain body dissatisfaction and disordered eating independently, except for the relationship between body dissatisfaction and the thinness-oriented TI model. An integration of the models better explained body dissatisfaction and disordered eating compared to either model alone. Notably, some findings did not align with the two frameworks, suggesting existing models may not adequately describe pathways through which disordered eating emerges in TGE populations. Specifically, body dissatisfaction showed no significant relationship with disordered eating and was not well explained by the TI model, and higher gender identity pride was related to greater disordered eating symptoms. Implications for clinical care and future research are discussed.
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Affiliation(s)
- Laura A Muratore
- Northern California Institute for Research; Department of Veterans Affairs, San Francisco; University of California, San Francisco; San José State University
| | - Annesa Flentje
- Community Health Systems and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
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43
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Springmann ML, Svaldi J, Kiegelmann M. A qualitative study of gendered psychosocial processes in eating disorder development. Int J Eat Disord 2022; 55:947-955. [PMID: 35608064 DOI: 10.1002/eat.23734] [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: 02/11/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Gender and sexual identity constitute social categories that have been found to be important when identifying persons at risk for eating disorders (ED), since prevalence rates are especially high for women as well as persons of gender and sexual minorities. The objective of this study is to enhance the understanding of how these social categories relate to ED development. METHOD A qualitative, inductive approach was used in order to develop empirically grounded hypotheses about gendered aspects in ED development. Data are 14 narrative interviews with persons of diverse sexual and gender identities who recovered from anorexia or bulimia nervosa. Interviews were analyzed in depth using Grounded Theory Methodology and Voice Centered Listening. RESULTS Results suggest that social experiences related to female gender, as well as social experiences related to non-compliance with social gender norms, can be important for ED development. Those social experiences were described as influencing participants' self-worth, body image and self-regulatory strategies, which were connected to ED symptomatology. DISCUSSION Future research should further validate the gendered aspects presented in this paper, since including a broader array of gendered social aspects in ED research might help to improve etiological understanding and prevention methods. PUBLIC SIGNIFICANCE STATEMENT This study contributes a special perspective to research on eating disorders and gender, because it is based on first-person perspectives of formerly affected persons and integrates the experiences of persons with different gender and sexual identities. Participants described four categories of gendered social experiences relevant for their eating disorders. We discuss the potential of these categories to guide future research on the development of eating disorders and their prevention.
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Affiliation(s)
| | - Jennifer Svaldi
- Department for Clinical Psychology and Psychotherapy, Tübingen University, Tübingen, Germany
| | - Mechthild Kiegelmann
- Department for Psychology, Karlsruhe University of Education, Karlsruhe, Germany
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Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM. Is It Autism? A Critical Commentary on the Co-Occurrence of Gender Dysphoria and Autism Spectrum Disorder. JOURNAL OF HOMOSEXUALITY 2022; 69:1204-1221. [PMID: 33852376 DOI: 10.1080/00918369.2021.1905385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An increasing amount of literature revealed a link between GD and ASD. Both GD and ASD are complex and heterogeneous conditions characterized by a large variety of presentations. Studies have reported that individuals with GD tend to have higher prevalence rates of autistic traits in comparison to the general population. The purpose of this commentary is to provide, through the description of a clinical case, our reading and a possible interpretation of the correlation of these two conditions in light of the several methodological limitations found in literature. We hypothesize that the traits often classified as autistic could be more accurately related to the distress and discomfort evoked by GD. The autistic traits of individuals with GD as forms of psychological defenses and coping mechanisms aimed at dealing with socio-relational and identity problems are discussed.
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Affiliation(s)
- Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Guido Giovanardi
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Eleonora Innocenzi
- Department of Letters and Philosophy, "Tor Vergata," University of Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Giorgio Caviglia
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
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45
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Barriers and Motives for Physical Activity and Sports Practice among Trans People: A Systematic Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14095295] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to analyze the research conducted between 2016 and 2021, regarding barriers and motives for the practice of physical activity (PA), physical exercise (PE), and sports among trans individuals. The searches were carried out in the PubMed, Scopus, and Web of Science databases between January 2022 and April 2022, and included papers published between October 2016 and December 2021. After reading the full text of the studies, and according to the eligibility criteria previously defined, only six studies met the inclusion criteria. Internal barriers were related to body dissatisfaction and discomfort, discrimination, and fear of other people’s reactions. Regarding external barriers, sports environment, PE environment, and sports participation policies and regulations are the main factors expressed by trans individuals that hinder the practice of sports and PE. The desire to achieve a specific physical form and the role that PE plays in the preparation and/or replacement of gender-confirming surgery are the most important motives for the practice. This study highlights the importance of continuing to fight the barriers encountered in the practice of PE and sports, suggesting the main motives that could help create better interventions, plans, and inclusive policies that may help promote its practice.
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Sexual Desire and Body Image. Gender Differences and Correlations before and during COVID-19 Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074351. [PMID: 35410031 PMCID: PMC8998239 DOI: 10.3390/ijerph19074351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022]
Abstract
Recent literature has extensively examined sexual behavior during lockdown due to COVID-19. However, there are no recent studies that have considered the relationship between body image quality, sexual arousability, and sexual anxiety. The present study has two main objectives: (1) to examine gender differences in bodily and sexual experience; and (2) the comparison of bodily and sexual experience, before and during the COVID-19 lockdown. A total of 301 adult subjects (161 women and 140 men) aged between 16 and 73 years (Mean = 37.4; S.D. = 10.3) participated in the study. Data on biographical information were collected via an online panel. The Body Uneasiness Test (BUT) and the Sexual Arousability Inventory (SAI) were used for the assessment. Univariate ANOVA showed worse scores for women, compared with men, in terms of body image avoidance, depersonalization, overall severity of body image quality, sexual arousability, and sexual anxiety dimensions. When compared against time, only women showed significant correlations between the function of sexual arousal and all parameters concerning body image alteration. Interestingly, these correlations were weak and sporadic before lockdown, but strong and numerous during lockdown. This finding suggests that the impact of COVID-19 restrictions affected the female population more, with a profound repercussion on self-image and sexual and mental well-being.
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47
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Pellicane MJ, Ciesla JA. Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis. Clin Psychol Rev 2022; 91:102113. [PMID: 34973649 DOI: 10.1016/j.cpr.2021.102113] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.
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MacKinnon KR, Kia H, Lacombe-Duncan A. Examining TikTok's Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups. J Med Internet Res 2021; 23:e30315. [PMID: 34889739 PMCID: PMC8704107 DOI: 10.2196/30315] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/30/2021] [Accepted: 11/02/2021] [Indexed: 01/30/2023] Open
Abstract
Social media is increasingly being leveraged by researchers to engage in public debates and rapidly disseminate research results to health care providers, health care users, policy makers, educators, and the general public. This paper contributes to the growing literature on the use of social media for digital knowledge mobilization, drawing particular attention to TikTok and its unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities (eg, equity-seeking groups). Setting the TikTok platform apart from other social media are the unique audiovisual video editing tools, together with an impactful algorithm, that make knowledge dissemination and exchange with large global audiences possible. As an example, we will discuss digital knowledge mobilization with trans and nonbinary (trans) communities, a population that experiences barriers to health care and is engaged in significant peer-to-peer health information sharing on the web. To demonstrate, analytics data from 13 selected TikTok videos on the topic of research on gender-affirming medicine (eg, hormonal therapy and surgeries) are presented to illustrate how knowledge is disseminated within the trans community via TikTok. Considerations for researchers planning to use TikTok for digital knowledge mobilization and other related community engagement with equity-seeking groups are also discussed. These include the limitations of TikTok analytics data for measuring knowledge mobilization, population-specific concerns related to community safety on social media, the spread of disinformation, barriers to internet access, and commercialization and intellectual property issues. This paper concludes that TikTok is an innovative social media platform that presents possibilities for achieving transformative, community-engaged knowledge mobilization among researchers, underserved health care users, and their health care providers, all of whom are necessary to achieve better health care and population health outcomes.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
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Sharp G. Genital Self-Image and Aesthetic Genital Surgeries: Novel Perspectives Across the Cisgender and Transgender Spectrum. Aesthet Surg J 2021; 41:NP2046-NP2052. [PMID: 34223889 DOI: 10.1093/asj/sjab272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Genital-focused body image concerns or negative genital self-image are a common experience across the gender spectrum, including among cisgender and transgender populations. Such concerns can result in lower psychological and sexual well-being. In this article, it is proposed that the development of genital self-image concerns may be partly explained by the theoretical framework of cisgenderism. This theory proposes that there are only 2 genders-men and women-and these are dictated solely by the appearance of the genitals. Any deviation from these 2 categories can result in discrimination, which particularly impacts transgender individuals. An increasing number of cisgender and transgender people are seeking out aesthetic genital procedures to alleviate genital self-image concerns (and gender dysphoria in transgender populations). The growing body of research suggests that cisgender and transgender men and women are relatively satisfied with the results of their genital procedures. However, this research is limited by a lack of standardized and validated patient-reported measures to evaluate surgical outcomes. Furthermore, despite negative genital self-image being a key motivator for surgery, it is often not included as an outcome measure. In this article, recommendations are proposed for conducting higher-quality evaluation studies of aesthetic genital procedures in cisgender and transgender populations. Moreover, future research and clinical directions are suggested to assist transgender men and women who choose not to undergo genital gender-confirming surgery. The vast majority of transgender individuals do not have this surgery and so are in great need of support in managing their gender dysphoria and negative genital self-image.
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Affiliation(s)
- Gemma Sharp
- National Health and Medical Research Council early career senior research fellow and clinical psychologist, Monash University, Melbourne, Victoria, Australia
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Burnell K, George MJ, Kurup AR, Underwood MK. "Ur a freakin goddess!": Examining Appearance Commentary on Instagram. PSYCHOLOGY OF POPULAR MEDIA CULTURE 2021; 10:422-433. [PMID: 35003883 PMCID: PMC8740949 DOI: 10.1037/ppm0000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Frequent use of highly visual online platforms such as Instagram may be linked to greater body image concerns. One prominent feature of Instagram is the ability to receive feedback in the form of likes and comments. The goal of this cross-sectional study (conducted in laboratory and online) was to examine college students' receipt of appearance commentary on their most recent Instagram posts, and how this relates to their self-reported body image concerns. The Instagram commentary that 337 students (M age=20.39) received on their posts was observationally coded for positivity and negativity. Receiving positive appearance commentary was common and linked to greater appearance-related social media consciousness, and, weakly, to body surveillance. There were no associations with self-objectification, appearance-contingent self-worth, facial satisfaction, and body dissatisfaction. Negative appearance commentary was not associated with body image concerns. Photos depicting only the self were especially likely to elicit positive appearance commentary. Females received more positive appearance commentary compared to males, whereas males received more negative appearance commentary. Future research should examine long-term effects of receiving appearance comments via Instagram.
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