Anorexia nervosa and gender dysphoria in two adolescents
Abstract
Little has been published about the co-occurrence of gender dysphoria (GD) and eating disorders (ED) in adults, with no cases described in the adolescent population. The emphasis on body shape in both conditions suggests that there may be some overlap in symptomatology. We report two adolescent cases initially diagnosed with anorexia nervosa who later met criteria for GD. The drive for thinness for the 16-year-old male was associated with a wish to achieve a feminine physique whereas there was an emphasis for stunted breast growth and a desire for muscularity in the 13-year-old female. Complexities in presentation, evolution of symptoms over time, and the treatment of the two cases are discussed. Clinicians should inquire about sexual issues in the presentation of ED and should monitor for symptoms of GD, not only at initial presentation, but throughout treatment, especially as weight gain progresses.
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Transmasculine adolescents may also engage in restrictive eating behaviors in order to reduce the appearance of female secondary sex characteristics such as breasts.
“Transmasculine adolescents may also engage in restrictive eating behaviors in order to reduce the appearance of female secondary sex characteristics such as breasts (Couturier et al., 2015; Hepp & Milos, 2002).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Couturier et al., 2015
Similar intentions were reported in previous case studies, in which TGAs' disordered eating developed not out of a general fear of weight gain, but specifically to alter or delay expression of secondary sex characteristics.
“Similar intentions were reported in previous case studies, in which TGAs’ disordered eating developed not out of a general fear of weight gain, but specifically to alter or delay expression of secondary sex characteristics (Couturier et al., 2015; Strandjord et al., 2015).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Couturier et al., 2015
Previous case studies have also found TGAs restricting intake to conform to gender norms as well as to minimize secondary sex characteristics.
“Previous case studies have also found TGAs restricting intake to conform to gender norms (Gordon et al., 2016) as well as to minimize secondary sex characteristics (Couturier et al., 2015; Strandjord et al., 2015).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Couturier et al., 2015
Previous case studies have shown that TGAs may not express gender identity concerns to treatment providers until weight restoration occurs.
“Previous case studies have similarly shown that TGAs may not express gender identity concerns to treatment providers until weight restoration occurs (Couturier et al., 2015; Strandjord et al., 2015).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Couturier et al., 2015
When the adolescents in these prior cases began hormone therapy or puberty blockers, they experienced improvement in body image and a reduction in disordered eating behaviors.
“when the adolescents in these prior cases began hormone therapy or puberty blockers, they experienced improvement in body image and a reduction in disordered eating behaviors.”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Couturier et al., 2015
In the absence of gender-affirming care, disordered eating may be unlikely to improve, as the resistance to weight gain and to the development of secondary sex characteristics may be strong.
“Research then suggests that in the absence of gender-affirming care, disordered eating may be unlikely to improve, as the resistance to weight gain and to the development of secondary sex characteristics may be strong (Couturier et al., 2015).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Couturier et al., 2015
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- Authors
- Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N.
- Affiliations
- McMaster University (CA)
- Corresponding author
- Couturier, Jennifer
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2014-11-25
- Volume
- 48
- Issue
- 1
- Pages
- 151-155
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W1545930268
- Cited by
- 74
- References
- 20
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 10 · 2023: 24 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 9 · 2015: 1
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Keywords
- anorexia nervosa, gender dysphoria, eating disorders, adolescents, co-occurring disorders, drive for thinness, body image, breast development, muscularity, eating disorder treatment, weight gain
- MeSH terms
- Adolescent, Anorexia Nervosa, Body Image, Female, Humans, Male, Motivation, Surveys and Questionnaires, Transsexualism, Weight Loss
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