Why Trans People Face Higher Risks of Eating Disorders

**Content warning: This blog includes mention of suicide. Please use your discretion when reading and speak with your support system as needed. If you are experiencing suicidal thoughts, help is available through The Trevor Project or by texting or calling 988.

At The Emily Program, we know that the journey to healing is deeply personal. We’re committed to creating a world where every individual feels seen, respected, and supported along their recovery path. For transgender and non-binary individuals, the road to recovery from an eating disorder can come with unique and often painful challenges—layered with identity-related stigma, trauma, and the complex relationship between body dysphoria and dysmorphia.

These experiences can make recovery feel out of reach, especially as access to inclusive care for transgender individuals is increasingly under threat.

The Emily Program’s Penny Gautreaux (she/they), MSW, LICSW, a CARE program therapist out of Ohio, and Val Ashby (she/her), MA, LPCC-S, an outpatient therapist in Cleveland, embody our commitment to affirming care. Penny, a transwoman in recovery, knows firsthand how the feeling of “being a stranger in one’s own body” can impact healing. Val, who describes herself as a fat, cis, queer, White woman, brings a grounded understanding of what it means to both experience and lack privilege. Together, their insights help us explore why transgender and non-binary individuals face elevated risks for eating disorders—and how supportive networks can make all the difference.

Why Eating Disorders Disproportionately Affect Transgender Individuals

Eating disorders are often stereotyped as illnesses that affect only thin, young, White, and cisgender individuals. However, as Val Ashby emphasizes, “Eating disorders do not discriminate. For a long time, the stereotype of a person with an eating disorder has been laden with elements of privilege—thin, young, White, and cis. But if this is our picture of the illness, what is our picture of recovery?”

Transgender and non-binary individuals often face complex and overlapping pressures that increase their risk for eating disorders. Yet studies have traditionally examined eating disorders through a binary lens, overlooking the full scope of challenges faced by transgender, non-binary, and gender-fluid people.

What Recent Findings Reveal:

Transgender adults and adolescents are diagnosed with eating disorders more often cisgender people (Diemer, E.W., 2018). They are also more likely to engage in disordered eating behaviors (Parker, L.L., 2020).

Trans and non-binary youth have higher rates of eating disorder diagnoses. This is especially true for trans boys/men and non-binary youth who were assigned female at birth (The Trevor Project, 2022).

Nine in ten transgender and non-binary youth experience dissatisfaction with their body. 88% attribute this to the mismatch between their gender identity and the sex they were assigned at birth (The Trevor Project, 2022).

Transgender college students are more than four times more likely than cisgender students to have an eating disorder diagnosis (Diemer, E.W., 2015).

These statistics highlight the compounded impact of eating disorders and mental health struggles in transgender communities. For example, LGBTQ youth with a diagnosed eating disorder report nearly four times the odds of a suicide attempt in the past year compared to those without an eating disorder (The Trevor Project, 2022). Such stark numbers highlight the urgent need for compassionate, affirming care.

For many transgender people, body image struggles stem from a complex interplay of body dysmorphia (a distorted perception of one’s appearance) and body dysphoria (discomfort due to a mismatch between gender identity and physical characteristics).

Val explains, “People who identify as trans and/or non-binary struggle with the intersectionality of societal factors—thin privilege, fatphobia, health and wellness culture—compounded by gender-related pressures, such as the impact of gender invalidation and transphobia.” For some, “eating disorders can serve as a way to feel ‘safe’; they may allow the person to feel a sense of control, autonomy, and validation in a world that is often critical and oppressive.”

“Being transgender or non-binary is a different experience than being cis,” adds Penny Gautreaux, “but that doesn’t mean that the same factors that impact cis folks aren’t also involved. The pressure to be thin, toned, and to equate those things with health and moral virtue is the same for trans folks. However, for us, the ways we want to force our bodies to be a size or shape they are not can be much more intense. The desire to be accepted physically or the pressure to ‘pass’ can amplify stress, which often leads to disordered eating behaviors and eating disorders.”

Beyond these internal pressures, transgender individuals often face systemic challenges. Higher rates of discrimination, poverty, housing insecurity, and employment barriers lead to a higher risk of food insecurity, especially for trans men. Food insecurity is closely linked with disordered eating, driving cycles of bingeing and restriction as food becomes available.

Our society generally views eating disorders through a narrow lens of privilege. As a result, the lack of representation of transgender individuals in research and recovery spaces can create an additional barrier to seeking help. “Representation in recovery as a gender-variant person is more important now than ever,” Val shares, noting how traditional models of femininity and masculinity within the community tend to favor a thin ideal, leaving many feeling unseen and unsupported.

Understanding the personal and systemic challenges that transgender and non-binary individuals face is essential. This awareness opens the door to inclusive support that promotes true healing.

The Power of Community and Chosen Family in Recovery

For many transgender individuals, recovery requires a strong community that understands the unique challenges they face. Trans individuals may experience isolation and a sense of “otherness,” sometimes compounded by strained or absent biological family relationships. For these reasons, chosen family and LGBTQ+ communities can be lifelines—providing emotional validation and practical resources that make recovery more accessible and less isolating.

“Chosen family is deeply important to many trans experiences,” Penny explains. “Often, we are partially or fully rejected by our blood relations and born-in natural supports, such as teachers or faith communities. This lack of acceptance exposes us to vulnerabilities but also tends to lead to strong, insular communities. Working with these communities in a supportive and holistic way helps change values and creates space for recovery.”

Val further emphasizes the importance of connection: “As a provider working with this population, the number of clients who have come out to me or said, ‘You are the only person who knows,’ demonstrates the immense loneliness, isolation, and feelings of ‘otherness’ that trans and non-binary people experience. Having just one accepting adult in their lives can significantly reduce risks of mental health issues, including suicide.”

The Role of Supportive Communities:

Identity Validation: Support from chosen family provides vital affirmation, allowing individuals to feel truly seen and valued in their identity. This acceptance can help dismantle internalized stigma and build self-compassion.

Safe Spaces for Open Reflection: In these communities, many people find judgment-free environments to discuss body image concerns, gender dysphoria, and recovery goals. These safe spaces allow individuals the freedom to process the complex emotions of recovery.

Access to Gender-Affirming Resources: Supportive networks connect individuals with essential resources—such as gender-affirming clothing, safe providers, and inclusive support groups. Access to these practical resources can lead to a sense of belonging and greater comfort in one’s body and identity.

Encouragement of Self-Advocacy: “Approaching recovery communally allows individuals to become leaders of their community,” explains Penny. “Many trans folks are forced to grow up early and may lack leadership skills due to the absence of support structures.” Supportive communities offer affirming spaces to nurture self-advocacy and leadership, empowering individuals to share their recovery journeys both within and beyond their community. As Penny notes, “Creating leaders in recovery benefits everyone.”

At The Emily Program, we recognize the essential role of community in eating disorder recovery and encourage support from chosen family and support networks. These connections create a compassionate, affirming space where each person feels understood, respected, and supported in their identity and healing journey.

The Emily Program’s Gender-Affirming Approach to Eating Disorder Recovery

For transgender and non-binary individuals, affirming mental health care isn’t just essential—it can be life-changing. But effective care requires more than just access; it demands an ongoing commitment to practices that honor each person’s identity, unique needs, and individual path to healing.

At The Emily Program, our approach to affirming care is rooted in practical, inclusive actions that create a truly welcoming and supportive environment. Central to this commitment is our Equity, Diversity, and Inclusion (EDI) Council—a cross-program team that shapes our policies and practices to uplift and support every client. The EDI Council informs our culturally competent staff training and guides daily practices that prioritize inclusivity, compassion, and respect across all our programs.

Our approach recognizes that transgender and non-binary clients encounter specific challenges in eating disorder recovery. For instance, gender dysphoria often overlaps with body image concerns, which can increase the likelihood of eating disorder behaviors as a coping mechanism. At the same time, we understand that not all transgender or non-binary individuals experience gender-related concerns. Our providers are trained to deliver a recovery experience that is sensitive, personalized, and attuned to each client’s unique needs and gender identity.

“The Emily Program considers transgender and nonbinary clients in myriad ways,” explains Penny. “Our documentation is inclusive in language, and our providers are trained on the unique challenges we face. In my experience, cis colleagues are willing to listen and adapt based on feedback. This openness and willingness to learn make a real difference.”

Val emphasizes the importance of individualized treatment that respects the complexities of recovery for transgender and non-binary clients. “Our treatment plans include identifying goals around gender identity and variance. As an ED clinician, common messages of body acceptance like ‘your body is not the problem’ can, at best, miss the mark, and at worst, invalidate the experience of gender-variant people.”

How The Emily Program Practices Gender-Affirming Care:

Inclusive Language and Practices: Respecting clients’ chosen names and pronouns is fundamental. Val highlights that this respect extends to every detail, from inclusive intake forms to gender-neutral restrooms. In our virtual programs, clients display their names and pronouns, reinforcing that they are safe to bring their full identities into the therapeutic space.

Comprehensive Staff Training: Our therapists, clinicians, and support staff receive ongoing training on issues impacting the LGBTQ+ community, especially around the intersections of gender identity and eating disorders. This education encourages our team to explore privilege, recognize internalized biases, and offer compassionate, inclusive support.

Affirming Therapeutic Environment: Beyond procedural inclusivity, we focus on active listening to validate the unique challenges our clients face. In 2023, Val launched an LGBTQ+ body image group specifically for clients whose recovery goals may not align with their gender identity. “I am so proud of this group,” she shares. “Each week, clients show up for each other to provide support, encouragement, and validation. The sense of camaraderie is so inspiring, and I am so honored to be a part of this with them.” One client’s reflection highlights the impact: “It’s hard enough to recover, but now I am expected to recover AND appreciate a body that feels ‘wrong’ for me?” Insights like these guide us in tailoring our support, ensuring clients feel truly seen and respected.

Cultivating Identity-Driven Resilience: Resilience is more than a coping skill—it’s a foundation for thriving. By helping clients define and celebrate their unique LGBTQ+ identities, we foster resilience that enhances self-worth, boundary-setting, and social connection. This approach aligns with clients’ recovery efforts, as they as they work to counter negative self-talk and build identities that extend beyond their eating disorders. Strengthening clients’ capacity to face external challenges empowers them with a deeper sense of self and purpose.

For many transgender individuals, past healthcare experiences may have been dismissive, isolating, or even traumatic, involving anything from overt discrimination to subtle invalidations. At The Emily Program, we are committed to providing a different kind of care—one where each client is valued as they are and empowered on their healing path. Here, everyone deserves to feel at home in their identity and body, supported by care that meets them exactly where they are.

Supportive Steps for Trans and Non-Binary People Beginning Recovery

Taking the first step toward recovery can feel daunting. This is especially true if past healthcare experiences have left you feeling unseen or misunderstood. But know this: recovery is possible, and you don’t have to do it alone.

Val offers this heartfelt encouragement:

“All people deserve love, care, compassion and recovery. If you are struggling, know that your voice and your life matter. I am grateful and honored to work with all of my clients who continue to inspire me every day. It is okay to be scared, unsure, nervous and lost. Trying to recover is hard, but you don’t have to try alone. Together, we all can find a way.”

Penny, who has navigated her own recovery journey, shares a powerful message of hope:

“I suffered with an eating disorder, without support, for over 20 years. The experience of feeling like a stranger in my own body as a transwoman and hating my body because of my eating disorder was frankly overwhelming. I began the process of transition almost a decade before I got help with my eating disorder. Through that long ten years, I developed a feminine identity that made me feel like I knew who I was. I also found a community of wonderful Queer folks and allies that helped me feel like I belonged somewhere as well. I was still stuck in the eating disorder though. Stuck as my own fiercest critic, far crueler to myself than any transphobe could be. Every time I saw the person I had worked so hard to become in the mirror I still hated her. When I got help for my eating disorder, I learned to show compassion to the girl and woman who had been ripped out of her life for trying to be the person she knew she was. I realized how strong I am, and how much of life I was missing. For me, eating disorder recovery was the piece I needed to start celebrating myself and I am a happier, gentler, better woman for it. I hope that you have a similar experience. The world needs every one of us. Our perspective matters, perhaps now more than ever.”

Steps to Help You Get Started:

Acknowledge Your Experience Without Judgment: If you’re wondering whether you might have an eating disorder, know that your feelings are valid and you’re not alone. Recognizing this possibility is a meaningful step. It’s okay if it feels uncertain or overwhelming. Take a quiet moment to acknowledge your experiences with compassion. When you feel ready, consider taking our confidential eating disorder assessment quiz for more clarity.

Reach Out to Someone You Trust: Sharing your thoughts with someone you trust—be it a friend, chosen family member, or therapist—can help ease the weight of this journey. Connecting with someone who respects and supports you can lighten your emotional load. It can also make exploring your options feel safer. If speaking feels difficult, try writing down your thoughts first.

Seek LGBTQ+ Affirming Care: A gender-affirming, culturally competent provider can make all the difference in your recovery. Look for specialized programs like The Emily Program that are experienced in supporting individuals with gender dysphoria and eating disorders. Not sure where to start? LGBTQ+ organizations like The Trevor Project and the National Alliance for Eating Disorders can connect you with providers who prioritize gender-affirming care, so you don’t have to face this journey alone.

Connect With Peer Support Communities: There’s strength in shared experience. Engaging with others who have faced similar challenges—whether online or in person—can bring encouragement, understanding, and hope. Support groups like the Alliance’s LGBTQ+ Pro-Recovery Virtual Support Group offer safe spaces where you can discuss both gender identity and eating disorder recovery openly. You can find more resources and community through links here.

Remember, you don’t have to face this journey alone. Recovery is possible, and each step you take is a powerful act of courage and self-care. At The Emily Program, we’re here to walk beside you. We’re here to help you find a path to a life that feels authentic and free from the weight of an eating disorder. You deserve a future that celebrates every part of who you are.

At The Emily Program, we believe in providing treatment that truly respects, values, and uplifts every individual. Eating disorder care should be accessible and affirming for all, in an environment that celebrates each unique identity. If you or someone you know is struggling, please don’t hesitate to reach out. Let’s build a pathway to healing that reflects and honors who you are. Start your journey with us by completing our online form or calling 1-888-364-5977.

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