Why do gender diverse people have higher rates of eating disorders and disordered eating?

Eating disorders can have many contributors. Some of the common factors that create elevated risk are gender dysphoria, minority stress, and co-occurring neurodivergence.

Gender Dysphoria

Gender diverse young people often experience gender dysphoria. This is the distress that can occur when there is a mismatch between a person’s gender identity and sex characteristics, as well as from social misrecognition and structural barriers to affirmation.

Some trans young people report changing their eating or exercise to influence how their bodies are read as gendered, to minimise or enhance certain features, to suppress menstruation, and to delay or stop puberty when access to gender affirming care is limited. In one US study, 63% of trans young people reported engaging in disordered eating to align their bodies with their gender identity. In another study, 75% of trans young people with disordered eating were reported to be doing so to suppress their puberty.

Risk of disordered eating increases when dysphoria is high, support is limited, and gender affirmation is delayed. When gender affirming care is coordinated with eating disorder care, many people report improved body satisfaction and, for some, fewer disordered eating symptoms.

Minority Stress

Minority stress is the idea that higher rates of mental health problems in marginalised groups arise from stigma, discrimination, social exclusion, and barriers to care, rather than from being trans itself. For trans young people, experiences such as misgendering, bullying, harassment, unsafe school environments, and gaps in healthcare are linked with higher odds of binge eating, fasting, self-induced vomiting, and compulsive exercise.

Family support, school connectedness, and access to social, medical, and legal gender affirmation are each associated with better mental health and lower risk of disordered eating.

Co-occurring Neurodivergence

Neurodivergent means people whose brains learn, sense, and process the world differently from what society expects. This includes Autistic people and people with attention deficit hyperactivity disorder (ADHD). Trans young people are more likely than their cisgender peers to be neurodivergent. Neurodivergent people also have higher rates of disordered eating and eating disorders than people who are not neurodivergent. While being neurodivergent isn’t in itself a risk factor, certain traits like sensory sensitivities, executive function differences, and interoceptive differences can contribute to an elevated risk. When a young person is both gender diverse and neurodivergent, risks can compound, and disordered eating might serve multiple functions (e.g., managing dysphoria and sensory sensitivities to certain textures).

What are the signs of disordered eating?

Disordered eating can look different for each person. Below are some of the common signs that could indicate disordered eating in a trans young person:

• Withdrawing from social meals: regularly avoids eating with others or makes excuses to skip shared meals
• Disguising or hiding food: moves food around, hides it, or disposes of it instead of eating
• Obsession with ‘healthy eating’: fixated on strict rules or cutting out entire food groups
• Overconsumption of gum, caffeine, or soft drinks: uses these to blunt appetite or replace meals
• Constant monitoring of appearance: frequent weighing, measuring, pinching, or mirror checking
• Wearing baggy clothes or layering: uses oversized or multiple layers to conceal body shape or changes
• Preoccupation with ‘passing’: fixates on being read as their gender and closely monitors body features
• Spending long periods in the bathroom: especially during or after meals
• Using excessive deodorant or mouthwash: attempts to mask the smell of vomiting or laxative use
• Rigid food rules: inflexible rules about what, when, or how much to eat
• Emotional distress around food: high anxiety, upset, or irritability at mealtimes
• Anxiety about transition weight requirements: concerned about meeting clinic weight criteria for hormones or surgery
• Withdrawing from support: pulling away from family, friends, or services previously valued

Getting Help

When to seek urgent medical care

• If you notice signs of medical instability such as fainting or near-fainting, chest pain, shortness of breath, confusion, severe dehydration, vomiting that will not stop, or you suspect very low intake for several days, take your child to an emergency department or call 000 now.
• Emergency services will assess for complications like electrolyte disturbance and heart rhythm problems that sometimes require admission.

If you need immediate emotional support:

• For specialist eating disorder support and referral guidance, contact the Butterfly National Helpline: 1800 ED HOPE 1800 33 4673 from (8am to midnight)
• QLife 1800 184 527 (3pm-midnight) for LGBTIQA+ peer support
• Lifeline 13 11 14
• Kids Helpline 1800 55 1800.
• 13YARN 13 92 76 for Aboriginal and Torres Strait Islander people

First Steps in the Health System

1. Book a long GP appointment: Ask about a Medicare Eating Disorder Plan if your child is eligible. This can include up to 40 psychology sessions and 20 dietetics sessions in a 12-month period, plus medical monitoring and referrals.
2. Find credentialed clinicians: Use the ANZAED connect·ed directory to locate Credentialed Eating Disorder Clinicians in psychology, dietetics, and general practice.
3. Ask for baseline checks: Request bloods, ECG, weight taken privately or blind if helpful, and a risk plan for home and school.
4. Request a referral to a local child and adolescent eating disorder service and ask the GP to share information with any gender clinic involved, so plans are aligned.

Preparing for your first appointments

Prepare:

• A brief timeline of eating, activity, mood, school, and social changes
• Current medicines, puberty status, and any gender affirming care underway or planned
• Any purging, laxative use, fainting, injuries, or exercise patterns
• Sensory preferences, safe foods, and routines that help your child eat
• Names and contacts for all services and school staff, so the team can coordinate

Digital treatment and carer support available anywhere in Australia:

• InsideOut eClinic provides free digital therapies, screening tools, and carer resources, no referral needed
• headspace Brief BEeT free binge eating eTherapy for ages 16 to 25
• The National Eating Disorder Collaboration provides national evidence-based resources for families and supports
• Eating Disorders Families Australia Fill The Gap free one-to-one counselling for carers

Coordinating eating disorder care with gender affirmation

• Tell every provider your child’s name and pronouns and ask that this is respected and recorded.
• Request one shared plan that integrates eating concerns and gender dysphoria so the approaches work together.
• Ask for practical adaptations such as private or blind weighing, non-gendered materials and groups, and attention to dysphoria triggers.
• Ask teams to agree on timing so that nutrition therapy, psychotherapy, and any gender affirming steps support each other.

Helpful phrases for appointments:

Please record my child’s correct name and pronouns and ensure all staff use them.

 

We want a plan that addresses eating concerns and gender dysphoria together. Can you coordinate with our gender clinic or GP?

Resources you can share with your child’s team

• Twenty10’s Safe and Affirmed guidesheet on eating disorders and gender diversity with key messages and practice tips for clinicians, school staff, and coaches

What good, affirming eating disorder care looks like:

• Use correct name and pronouns and avoid gendered assumptions in groups and materials
• Involve parents or carers while respecting the young person’s autonomy
• Screen for dysphoria, minority stress, and neurodivergence, and address these in treatment
• Offer private or blind weighing where appropriate
• Provide a coordinated plan across medical, dietetic, psychology, school, and family settings
• Offer carer education and peer support