A new study has come out examining the differences between eating disorders and transsexuality. It’s not immediately obvious why those two should be compared. The causes of both are unknown. When you don’t know the cause of a phenomenon it’s often useful to compare it to other phenomena that seems similar. Both eating disorders and transsexuality can be categorized as body-centered phenomena; eating disorders involve weight, transsexuality involves sex characteristics. However there are differences; people with eating disorders are more likely to have other psychiatric diagnoses (e.g., borderline personality disorder) than trans people are. Trans people seem to have psychiatric diagnoses as frequently as the general population, though the data are still tentative.

This Italian study compared three groups, all roughly the same size (100 participants):

Trans people, both trans women and trans men. Both pre-op (no sexual reassignment surgery) and post-op folk were included. There were roughly equal numbers of trans men and trans women, and of pre-ops and post-ops. Trans participants had to have a diagnosis of Gender Identity Disorder.

People with eating disorders, divided into three groups: anorexia nervosa, bulimia nervosa and binge eating disorder. These participants were mostly female, except in the binge eating group which was half female.

Control participants with normal BMI who did not have an eating disorder and were not trans.

What did they measure? The researchers measured demographics, “anthropometric measurements” such as height and weight, psychiatric evaluations to verify diagnoses, psychological symptoms, and body uneasiness. Body uneasiness is multifaceted, including general body/weight dissatisfaction, compulsive self-monitoring (e.g., spending a lot of time in front of the mirror), feeling disconnected from one’s body, and worrying about specific body parts.

What did they find? Results included…

Pre-op trans folk had: a) higher levels of body uneasiness than people with eating disorders, b) lower levels of body satisfaction than post-op trans folk, and c) higher levels of depersonalization than all other groups.

There was no difference in overall body uneasiness between trans men and trans women. However, there were differences in various aspects of body uneasiness. Trans women were more likely to be concerned about weight gain than trans men. Trans women also self-monitored about as much as people with eating disorders, more than trans men and the control group.

Trans participants had lower levels of psychopathology than people with eating disorders. There was no difference between the trans participants and the control group for psychopathology.

Pre-op trans women were more likely to have adjustment disorder than all the other groups.

So how do we interpret this? First there’s the difference between trans folk and people with eating disorders. This study confirmed the findings of previous studies. It agrees that trans people are much less likely to have psychiatric diagnoses than people with eating disorders. It also agrees that, in general, trans people are not at elevated risk for psychopathology than the general population. Given the way many psychiatric disorders come in clusters (e.g., mood and anxiety disorders), this may be further evidence that transsexuality is not a psychiatric condition.

The finding that pre-op trans women are more likely to have adjustment disorder requires explanation. Adjustment disorder is not like mood or psychotic disorders. It means that the person is having difficulty adjusting to a life change. For pre-op trans women, the source is obvious: their transition is a major life change and a major stressor. The fear of being “outed” and assaulted or ostracized is very real. Pre-op trans women are also likely o be early in transition and hormone therapy and have a harder time “passing” than trans men.

Why might trans women worry about weight more than trans men? The authors comment, “It could be speculated that [trans women]’s drive for thinness is a way to suppress masculinity and to correspond to a female ideal of attractiveness.” Absolutely! Trans women are women, and so they get all the societal messages encouraging thinness that all Western women receive.

I do, however, feel that one “finding” of theirs must be questioned. As part of demographics, the authors asked about sexual orientation. They then categorized their participants by attraction according to “genotypic sex” (XX, XY, XXY, XO, etc) So when they later reported that their trans participants were more likely to be attracted to the same genotypic sex than their controls and people with eating disorders, they were actually comparing straight trans people to gay cis people. That makes no sense! Of course there were more straight trans people than gay cis people – there are more straight people than gay people overall. Further, “genotypic sex” as a category makes no sense unless you actually check the genotype! Even then, it doesn’t necessarily correspond to phenotypic sex (the sex that the person looks like).The primary limitation to this study is their inclusion of only gender binary trans people who were diagnosed with Gender Identity Disorder. This excludes all genderqueer folk, who may have more difficulty with transition because of societal pressure to be seen as either male or female. Otherwise, I think this study was fairly well put together.

The authors conclude saying that “Our findings suggest that in eating disorder patients [body] uneasiness is primarily linked to general psychopathology, whereas in [transsexuality] this relationship is lacking.” In other words, they suggest that eating disorders come from a general state of psychological illness and that transsexuality does not. The data I have seen, as well as anecdotes from the trans community, agree with this conclusion.

Abstract.

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