Prevalence, Disability, and Mental Health Correlates with Eating Disorders in Trans-Nonbinary Coloradans

Background and Purpose:

Eating disorders (EDs) are debilitating, multi-faceted, potentially deadly illnesses lasting 2.5-5.5 years if untreated. Trans and non-binary people (TNB) suffer from EDs at higher rates than cisgender counterparts. Disparities may be explained by minority stress, desire to “pass” (leading to weight manipulation), and weight requirements for gender-affirming care. EDs often co-occur with other chronic health and mental health conditions including depression, suicidality, anxiety, traumatic experiences, and PTSD, and TNB people experience these conditions at disparate rates. TNB people also face barriers accessing general healthcare, gender-affirming care, ED screening, and ED treatment. Taken together, these findings suggest the need for collaborative, interdisciplinary research and treatment options to support TNB individuals with EDs.

ED research among TNB people is limited. This study investigated the following research questions, using the OneColorado dataset (a representative sample of adult TNB Coloradans):

RQ1: Do ED rates vary significantly by demographic factors (disability, gender, race, age, income, or gender) in TNB Coloradans?

RQ2: Are EDs correlated with other mental health conditions (anxiety, depression, traumatic experiences, or PTSD)?

RQ3: Of TNB individuals seeking healthcare, how many have likely EDs?

Methods:

Secondary data analysis was conducted using a cross-sectional survey of TNB people living in Colorado (N=448).

ED symptomology was assessed with the Eating Disorder Examination-Questionnaire-7. Scores greater than 3.64 indicated the presence of a likely ED.

Depression was assessed using the Patient Health Questionnaire-2 (PHQ-2), and anxiety was assessed using the Generalized Anxiety Disorder-2. Participants endorsing trauma (dichotomous question) completed the Primary Care Post-Traumatic Stress Disorder (PC-PTSD-5), which assessed for Post Traumatic Stress Disorder (PTSD). Demographic variables included age, race/ethnicity, gender, endo/intersex status, disability status, disability type, and income.

Results

ED rates were high (54%) and varied across demographic factors. Indigenous participants had significantly higher log odds of having an ED (68%) compared to white respondents (48%) (p=0.048). Age was significantly positively associated with the log odds of having a likely ED (p=0.045).

Depression and anxiety were significantly correlated with EDs (p=0.023, p=0.009). Trauma history (p<0.001), lifetime suicide attempt (p=0.001), non-suicidal self-injury (NSSI) (p=0.011), and anxiety severity (p=0.004) were significantly correlated with ED severity. Contrary to previous literature in cisgender samples, disability was not associated with ED risk.

Of those seeking healthcare or mental healthcare in the last year, 47% and 48% (respectively) had likely EDs.

Conclusions and Implications

This study adds to literature regarding the prevalence of EDs in TNB people, using a representative sample of Coloradans with diverse races and genders. Findings suggest that TNB individuals are at high risk for EDs, and that these concerns likely coincide with multiple other conditions. Further, almost half of TNB individuals seeking health/mental healthcare endorsed a likely ED, suggesting that screening all TNB patients for eating concerns is imperative.