Caring for Transgender Youth with Eating Disorders in a Day Treatment Program

The treatment of transgender youth with an eating disorder presents particular considerations due to the unique combination of body dissatisfaction, drive for thinness, malnutrition coupled with the evolving gender identity in the midst of biological and physical changes. At this time, public awareness, societal acknowledgment and legislative initiatives have led to wider acceptance of Lesbian, Gay, Bi-sexual and Transgender rights. However, at the same time, transgender youth are at increased risk for mental health problems, including eating disorders. To describe two cases of trans adolescents with anorexia nervosa treated in a day treatment program. In this paper, the two clinical vignettes of transgender adolescent with anorexia nervosa will be discussed. The focused care included specific attention to the initial disclosure of gender identity in a safe space, name and pronoun preferences as well as wardrobe and hair style changes. In addition, treatment focused on the reduction of social anxiety around meal consumption with special attention given to the impact of weight on the development of secondary sex characteristics. Themes of identity, rejection and secrecy were explored. In summary, the treatment of transgender youth with anorexia nervosa is more complex than treatment of cis gender youth. Additional issues, such as hormonal treatments, the development of secondary sexual characteristics as well as social and cultural factors can exacerbate eating disorder symptoms. Treatment should focus on understanding the etiology and the trajectory of the disorder within this lens.