Gender Dysphoria, Eating Disorders and Body Image: An Overview

Author(s): Walter Milano, Paola Ambrosio, Francesa Carizzone, Valeria De Biasio, Giuseppina Foggia, Anna Capasso*

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders

Volume 20 , Issue 4 , 2020

DOI : 10.2174/1871530319666191015193120

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Graphical Abstract:


Abstract:

Background: Gender dysphoria is a clinical condition in which a state of inner suffering, stress and anxiety is detected when biological sex and a person's gender identity do not coincide. People who identify themselves as transgender people are more vulnerable and may have higher rates of dissatisfaction with their bodies which are often associated with a disorderly diet in an attempt to change the bodily characteristics of the genus of birth and, conversely, to accentuate the characteristics of the desired sexual identity.

Aim: The purpose of this work is to examine the association between dissatisfaction with one's own body and eating and weight disorders in people with gender dysphoria.

Results: Gender dysphoria and eating disorders are characterized by a serious discomfort to the body and the body suffers in both conditions. The results of our study suggest that rates of pathological eating behaviors and symptoms related to a disordered diet are high in patients with gender dysphoria and that standard screening for these symptoms must be considered in both populations at the time of evaluation and during the course of the treatment.

Conclusion: In light of this evidence, clinicians should always investigate issues related to sexuality and gender identity in patients with eating disorders, to develop more effective prevention measures and better strategies for therapeutic intervention.

Keywords: Body image, eating disorders, gender dysphoria, gender identity, anorexia nervosa, bulimia nervosa.

[1]
Cuzzolaro, M.; Milano, W. Gender idendity, sexual orientation, body image, eating, and weight” chapter on.Body image, eating, and weight. A guide to assessment, treatment, and prevention; Cuzzolaro, M; Fassino, S., Ed.; Springer International Publishing AG, 2018.
[http://dx.doi.org/10.1007/978-3-319-90817-5_19]
[2]
Diagnostic and Statistical Manual of Mental Disorders, 5th ed; American Psychiatric Publishing: Washington, DC, 2013.
[3]
Diagnostic and statistical manual of mental disorders, 4th ed; American Psychiatric Association: Washington, DC, 1994.
[4]
Drescher, J.; Cohen-Kettenis, P.; Winter, S. Minding the body: situating gender identity diagnoses in the ICD-11. Int. Rev. Psychiatry, 2012, 24(6), 568-577.
[http://dx.doi.org/10.3109/09540261.2012.741575] [PMID: 23244612]
[5]
Richards, C.; Arcelus, J.; Barrett, J.; Bouman, W.P.; Lenihan, P.; Lorimer, S.; Murjan, S.; Seal, L. Trans is not a disorder – but should still receive funding. Sex. Relationship Ther., 2015, 30, 309-313.
[http://dx.doi.org/10.1080/14681994.2015.1054110]
[6]
Arcelus, J.; Bouman, W.P.; Van Den Noortgate, W.; Claes, L.; Witcomb, G.; Fernandez-Aranda, F. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur. Psychiatry, 2015, 30(6), 807-815.
[http://dx.doi.org/10.1016/j.eurpsy.2015.04.005] [PMID: 26021270]
[7]
Strandjord, S.E.; Ng, H.; Rome, E.S. Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. Int. J. Eat. Disord., 2015, 48(7), 942-945.
[http://dx.doi.org/10.1002/eat.22438] [PMID: 26337148]
[8]
Dhejne, C.; Van Vlerkenb, R.; Heylensc, G.; Arcelusd, J. Mental health and gender dysphoria: A review of the literature. Int. Rev. Psychiatry, 2016, 28(1), 44-57.
[9]
Dhejne, C.; Lichtenstein, P.; Boman, M.; Johansson, A.L.; Långström, N.; Landén, M. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One, 2011, 6(2) e16885
[http://dx.doi.org/10.1371/journal.pone.0016885] [PMID: 21364939]
[10]
Duišin, D.; Batinić, B.; Barišić, J.; Djordjevic, M.L.; Vujović, S.; Bizic, M. Personality disorders in persons with gender identity disorder. ScientificWorldJournal, 2014, 2014 809058
[http://dx.doi.org/10.1155/2014/809058] [PMID: 24959629]
[11]
Jones, BA.; Haycraftb, E.; Murjana, S.; Arcelus, J. Body dissatisfaction and disordered eating in trans people: A systematic review of the literature. Int. Rev. of Psychiatry, 2016, 28(1), 81-94.
[12]
Castellini, G.; Lelli, L.; Ricca, V. Sexuality in eating disorders patients: etiological factors, sexual dysfunction and identity issues. A systematic review. Horm. Mol. Biol. Clin. Investig., 2016, 25(2), 71-90.
[13]
Bandini, E.; Fisher, A.D.; Castellini, G.; Lo Sauro, C.; Lelli, L.; Meriggiola, M.C.; Casale, H.; Benni, L.; Ferruccio, N.; Faravelli, C.; Dettore, D.; Maggi, M.; Ricca, V. Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness. J. Sex. Med., 2013, 10(4), 1012-1023.
[http://dx.doi.org/10.1111/jsm.12062] [PMID: 23347389]
[14]
Becker, I.; Nieder, T.O.; Cerwenka, S. Body image in young gender dysphoric adults: A European multi-center study. Arch. Sex. Behav., 2016, 45(3), 559-574.
[PMID: 25836027]
[15]
Ålgars, M.; Alanko, K.; Santtila, P.; Sandnabba, N.K. Disordered eating and gender identity disorder: a qualitative study. Eat. Disord., 2012, 20(4), 300-311.
[http://dx.doi.org/10.1080/10640266.2012.668482] [PMID: 22703571]
[16]
Kraemer, B.; Delsignore, A.; Schnyder, U.; Hepp, U. Body image and transsexualism. Psychopathology, 2008, 41(2), 96-100.
[http://dx.doi.org/10.1159/000111554] [PMID: 18033979]
[17]
Vocks, S.; Stahn, C.; Loenser, K.; Legenbauer, T. Eating and body image disturbances in male-to-female and female-to-male transsexuals. Arch. Sex. Behav., 2009, 38(3), 364-377.
[http://dx.doi.org/10.1007/s10508-008-9424-z] [PMID: 19030979]
[18]
Hepp, U.; Milos, G. Gender identity disorder and eating disorders. Int. J. Eat. Disord., 2002, 32(4), 473-478.
[http://dx.doi.org/10.1002/eat.10090] [PMID: 12386912]
[19]
Hepp, U.; Spindler, A.; Milos, G. Eating disorder symptomatology and gender role orientation. Int. J. Eat. Disord., 2005, 37(3), 227-233.
[http://dx.doi.org/10.1002/eat.20087] [PMID: 15822092]
[20]
Haase, A.M.; Mountford, V.; Waller, G. Associations between body checking and disordered eating behaviors in nonclinical women. Int. J. Eat. Disord., 2011, 44(5), 465-468.
[http://dx.doi.org/10.1002/eat.20837] [PMID: 21661004]
[21]
Alfano, L.; Hildebrandt, T.; Bannon, K.; Walker, C.; Walton, K.E. The impact of gender on the assessment of body checking behavior. Body Image, 2011, 8(1), 20-25.
[http://dx.doi.org/10.1016/j.bodyim.2010.09.005] [PMID: 21093393]
[22]
Fairburn, C.G. Cognitive behavior therapy and eating disorders; Guilford Press: New York, 2008, p. 324.
[23]
Stice, E.; Shaw, H.E. Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. J. Psychosom. Res., 2002, 53(5), 985-993.
[http://dx.doi.org/10.1016/S0022-3999(02)00488-9] [PMID: 12445588]
[24]
Cuzzolaro, M.; Vetrone, G.; Marano, G.; Garfinkel, P.E. The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale. Eat. Weight Disord., 2006, 11(1), 1-13.
[http://dx.doi.org/10.1007/BF03327738] [PMID: 16801740]
[25]
Witcomb, G.L.; Bouman, W.P.; Brewin, N.; Richards, C.; Fernandez-Aranda, F.; Arcelus, J. Body image dissatisfaction and eating-related psychopathology in trans individuals: a matched control study. Eur. Eat. Disord. Rev., 2015, 23(4), 287-293.
[http://dx.doi.org/10.1002/erv.2362] [PMID: 25944170]
[26]
Hepp, U.; Milos, G.; Braun-Scharm, H. Gender identity disorder and anorexia nervosa in male monozygotic twins. Int. J. Eat. Disord., 2004, 35(2), 239-243.
[http://dx.doi.org/10.1002/eat.10247] [PMID: 14994364]
[27]
Winston, A.P.; Acharya, S.; Chaudhuri, S.; Fellowes, L. Anorexia nervosa and gender identity disorder in biologic males: a report of two cases. Int. J. Eat. Disord., 2004, 36(1), 109-113.
[http://dx.doi.org/10.1002/eat.20013] [PMID: 15185280]
[28]
Murray, S.B.; Boon, E.; Touyz, S.W. Diverging eating psychopathology in transgendered eating disorder patients: a report of two cases. Eat. Disord., 2013, 21(1), 70-74.
[http://dx.doi.org/10.1080/10640266.2013.741989] [PMID: 23241091]
[29]
Couturier, J.; Pindiprolu, B.; Findlay, S.; Johnson, N. Anorexia nervosa and gender dysphoria in two adolescents. Int. J. Eat. Disord., 2015, 48(1), 151-155.
[http://dx.doi.org/10.1002/eat.22368] [PMID: 25421316]
[30]
Bandini, E; Fisher, AD; Lo Sauro, C; Ricca, V Il disturbo di identità di genere Giorn Ital Psicopat. 2008, 14, 338-355.
[31]
Silverstein, B.; Carpman, S.; Perlick, D.; Perdue, L. Nontraditional sex role aspirations, gender identity conflict, and disordered eating among college women. Sex Roles, 1990, 23, 687-695.
[http://dx.doi.org/10.1007/BF00289256]
[32]
Khoosal, D.; Langham, C.; Palmer, B.; Terry, T.; Minajagi, M. Features of eating disorder among male-tofemale transsexuals. Sex. Relationship Ther., 2009, 24, 217-229.
[http://dx.doi.org/10.1080/14681990903082161]
[33]
Matthews-Ewald, M.R.; Zullig, K.J.; Ward, R.M. Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat. Behav., 2014, 15(3), 441-444.
[http://dx.doi.org/10.1016/j.eatbeh.2014.05.002] [PMID: 25064296]
[34]
Diemer, E.W. Genderi dentity, sexual orientation, and eatingrelated pathology in a national sample of college students. J. Adolesc. Health, 2015, 57(2), 144-149.
[35]
Brown, T.A.; Keel, P.K. The impact of relationships, friendships, and work on the association between sexual orientation and disordered eating in men. Eat. Disord., 2013, 21(4), 342-359.
[http://dx.doi.org/10.1080/10640266.2013.797825] [PMID: 23767674]
[36]
Boisvert, J.A.; Harrell, W.A. Homosexuality as a risk factor for eating disorder symptomatology in men. J. Men’s Stud., 2009, 17, 210-225.
[http://dx.doi.org/10.3149/jms.1703.210]
[37]
Austin, S.B.; Nelson, L.A.; Birkett, M.A.; Calzo, J.P.; Everett, B. Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students. Am. J. Public Health, 2013, 103(2), e16-e22.
[http://dx.doi.org/10.2105/AJPH.2012.301150] [PMID: 23237207]
[38]
Russell, C.J.; Keel, P.K. Homosexuality as a specific risk factor for eating disorders in men. Int. J. Eat. Disord., 2002, 31(3), 300-306.
[http://dx.doi.org/10.1002/eat.10036] [PMID: 11920991]
[39]
Share, T.L.; Mintz, L.B. Differences between lesbians and heterosexual women in disordered eating and related attitudes. J. Homosex., 2002, 42(4), 89-106.
[http://dx.doi.org/10.1300/J082v42n04_06] [PMID: 12243487]
[40]
Owens, L.K.; Hughes, T.L.; Owens-Nicholson, D. The effects of sexual orientation on body image and attitudes about eating and weight. J. Lesbian Stud., 2003, 7(1), 15-33.
[http://dx.doi.org/10.1300/J155v07n01_02] [PMID: 24815712]
[41]
Algars, M.; Santtila, P.; Sandnabba, N.K. Conflicted Gender Identity, Body Dissatisfaction and Disordered Eating in Adult Men and Women. Sex Roles, 2010, 63, 118-125.
[http://dx.doi.org/10.1007/s11199-010-9758-6]
[42]
McCreary, D.R.; Sasse, D.K. An exploration of the drive for muscularity in adolescent boys and girls. J. Am. Coll. Health, 2000, 48(6), 297-304.
[http://dx.doi.org/10.1080/07448480009596271] [PMID: 10863873]
[43]
Feldman, M.B.; Meyer, I.H. Eating disorders in diverse lesbian, gay, and bisexual populations. Int. J. Eat. Disord., 2007, 40(3), 218-226.
[http://dx.doi.org/10.1002/eat.20360] [PMID: 17262818]
[44]
Feldman, M.B.; Meyer, I.H. Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals. Psychiatry Res., 2010, 180(2-3), 126-131.
[http://dx.doi.org/10.1016/j.psychres.2009.10.013] [PMID: 20483473]
[45]
Blashill, A.J. Gender roles, eating pathology, and body dissatisfaction in men: a meta-analysis. Body Image, 2011, 8(1), 1-11.
[http://dx.doi.org/10.1016/j.bodyim.2010.09.002] [PMID: 20952263]
[46]
Meyer, I.H. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol. Bull., 2003, 129(5), 674-697.
[http://dx.doi.org/10.1037/0033-2909.129.5.674] [PMID: 12956539]
[47]
Frisell, T.; Lichtenstein, P.; Rahman, Q.; Långström, N. Psychiatric morbidity associated with same-sex sexual behaviour: influence of minority stress and familial factors. Psychol. Med., 2010, 40(2), 315-324.
[http://dx.doi.org/10.1017/S0033291709005996] [PMID: 19460186]
[48]
Díaz, R.M.; Ayala, G.; Bein, E.; Henne, J.; Marin, B.V. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am. J. Public Health, 2001, 91(6), 927-932.
[http://dx.doi.org/10.2105/AJPH.91.6.927] [PMID: 11392936]
[49]
Clements-Nolle, K.; Marx, R.; Guzman, R.; Katz, M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am. J. Public Health, 2001, 91(6), 915-921.
[http://dx.doi.org/10.2105/AJPH.91.6.915] [PMID: 11392934]
[50]
Nuttbrock, L.; Hwahng, S.; Bockting, W.; Rosenblum, A.; Mason, M.; Macri, M.; Becker, J. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J. Sex Res., 2010, 47(1), 12-23.
[http://dx.doi.org/10.1080/00224490903062258] [PMID: 19568976]
[51]
Clements-Nolle, K.; Marx, R.; Katz, M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. J. Homosex., 2006, 51(3), 53-69.
[http://dx.doi.org/10.1300/J082v51n03_04] [PMID: 17135115]
[52]
Fornari, C.; Dancyger, IF. Psychosexual development and eating disorders. Adolesc. Med., 2003, 14, 61-75.
[53]
Klump, K.L. Puberty as a critical risk period for eating disorders: a review of human and animal studies. Horm. Behav., 2013, 64(2), 399-410.
[http://dx.doi.org/10.1016/j.yhbeh.2013.02.019] [PMID: 23998681]
[54]
Schneeberger, A.R.; Dietl, M.F.; Muenzenmaier, K.H.; Huber, C.G.; Lang, U.E. Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review. Soc. Psychiatry Psychiatr. Epidemiol., 2014, 49(9), 1427-1445.
[http://dx.doi.org/10.1007/s00127-014-0854-8] [PMID: 24643297]


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Article Details

VOLUME: 20
ISSUE: 4
Year: 2020
Published on: 19 May, 2020
Page: [518 - 524]
Pages: 7
DOI: 10.2174/1871530319666191015193120
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