Eating disorders (EDs) among adolescents have mainly been studied in cisgender individuals, leaving a gap in knowledge about non-binary and transgender or gender diverse (TGD) adolescents. This lack of research has led to a deficiency in tailored interventions for these groups.
Traditional ED treatments may not fully address the unique experiences of TGD individuals, such as higher rates of comorbid mental health conditions and issues with body positivity approaches. This highlights the need for specific research and interventions targeted towards TGD youth.
To bridge this knowledge gap, a study compared ED symptom severity, depression, suicidality, and anxiety between cisgender and TGD adolescents undergoing higher levels of care ED treatment.
There is limited research on eating disorder treatment outcomes among transgender and gender diverse adolescents, making it difficult to assess whether current treatment approaches (developed in cisgender populations) are appropriate.
Methods
A retrospective cohort study was conducted involving adolescents (<18 years) admitted to a multi-centre higher levels of care eating disorders (ED) program in the US. Participants all met DSM-5 ED criteria through structured interviews with mental health professionals.
Measures of eating disorder symptoms, depression severity, suicidality, and anxiety were taken at admission and discharge, and changes were analysed using statistical methods.
Results
Out of 1,444 individuals, 617 completed admission and discharge measures, with 573 cisgender and 44 TGD adolescents. Main findings showed improvements in ED symptoms, depressive symptoms, suicidality, and anxiety for both groups.
Main findings
- ED symptoms improved significantly for both groups following interventions.
- Depressive symptoms decreased significantly with no significant differences between the groups.
- Suicidality and anxiety symptoms also improved significantly for both groups.
Sensitivity analyses
Results remained consistent even after excluding certain participants, indicating the robustness of the findings.
Results showed eating disorder, depression, suicidality and anxiety symptoms improved similarly for cisgender and transgender and gender diverse adolescents following interventions.
Conclusions
The study found that TGD adolescents showed similar improvements in ED symptoms compared to cisgender adolescents, but had higher anxiety, depression, and suicidality scores. This suggests that while ED treatments may work similarly for both groups, TGD individuals may require additional support for comorbidities.
Whilst transgender and gender diverse adolescents’ symptoms improved at similar rates to cisgender adolescents, levels of anxiety, depression and suicidality symptoms remained elevated at discharge.
Strengths and limitations
Strengths
- Statistical rigor and comparability.
- Enhanced internal validity.
Limitations
- Long-term measures
- Causality
- Attrition
- Small sample size and limited power
- Measurement validity
While Riddle et al. (2024) used robust statistical methods for their analyses, the small sample size of transgender and gender diverse individuals limits the ability to detect between-group differences and identify within-group variations.
Implications for practice
Treatment efficacy and adjunctive interventions
- The study suggests similar efficacy of ED treatments across cisgender and TGD adolescents.
- Adjunctive interventions tailored for TGD adolescents may be needed to address their specific challenges.
- Clinicians could consider screening TGD adolescents for comorbidities and making appropriate referrals for continued care post-discharge.
Longitudinal studies and replication
- Longitudinal studies with larger samples are needed to understand the long-term efficacy of ED treatment for both groups.
- Replication studies are encouraged to strengthen the existing literature in this area.
Intersectionality
- Cultural norms and racial identity may impact treatment responses and require further investigation.
Measurement validity
- Validation of measures for TGD individuals is necessary for accurate symptom assessment.
- Inclusion of gender dysphoria measures in future research could enhance understanding of treatment efficacy.
Assessing gender dysphoria
- Exploring the impact of gender dysphoria on treatment outcomes can provide valuable insights for tailored care.
As Riddle et al. (2024) only measured outcomes at admission and discharge, future research exploring differences in eating disorder treatment outcomes between transgender/gender diverse and cisgender adolescents should include a long-term follow-up to see if effects are maintained.
Statement of interests
None.
Links
Primary paper
Riddle, M., Blalock, D. V., Robertson, L., Duffy, A., Le Grange, D., Mehler, P. S.,…Joiner, T. (2024). Comparing eating disorder treatment outcomes of transgender and gender diverse adolescents with those of cisgender adolescents. International Journal of Eating Disorders.
Other references
References and links to related studies for further reading.
Photo credits
Credit to the photographers of the images used in this article.
