Trans Identification and Eating Disorders

By Eliza Mondegreen

One of the first heretical thoughts I entertained—the first time I realized young women like the young woman I was at the time were transitioning—was that we were seeing the next iteration of anorexia, a new and improved escape route for girls and young women who are uncomfortable with their changing bodies and the way the world reacts to those changes.

Years later, the parallels still strike me as both obvious and deep, becoming only more obvious and cutting ever deeper every day.

I know this terrain and I’ve written about this subject before:

There’s a lot I can’t reconjure about those hungry years. What exactly did I see when I looked in the mirror? Where did I think it would all end? What was my plan: to starve myself forever? Then what?

What I do remember:

That strange, brittle energy, like a candle burning furiously at the end of its wick. I was an immaterial being. I had crystalline thoughts.

That sense of purity and superiority I had, which was directed in particular at other girls, who lacked my discipline. Merely by filling out their bodies while I whittled mine away they proved that we had nothing in common. My self-image required their submission to what I rejected for myself. This wild idea of mine made me much lonelier than I ever should have been. I cut myself off from other girls, so their experiences couldn’t speak to me. And I remember seething when I read psychology texts that characterized anorexia as pathological compliance with beauty standards. (It’s not pathological compliance, it’s a pathological rejection! But what’s really pathological is acceptance.)

… I get it when I talk to young women who think they’ve found a new way out through transgender identification. I can recognize an escape hatch when I see one. And I know they’d hate the comparisons I draw. They’d hate to be enlisted in my arguments, recast as fresh examples of a familiar type. Doesn’t my woman’s body speak for itself, telling these young women I have nothing of any possible interest or value to say to their experience, that I’ve reconciled myself to the irreconcilable, just by eating just by calling myself a woman? I don’t have those crystalline thoughts anymore.

And here:

Medical providers tend to frame anorexia as the pathological pursuit of an (objectified) female form. I tend to see it as the opposite: a pathological rejection of objectification and sexual development. The fear isn’t becoming fat so much as becoming flesh. The anorexic persecutes the body that betrays ‘the self’ by its very existence: by its femaleness, by its soft curves and dark secrets, by blood, by the reproductive potential written into female flesh and by the things society writes on that flesh. Anorexics aspire to be pure spirit, pure intellect. They need only one food: not to violate the ‘self’ by becoming flesh.

Transition, too, scapegoats the body for its failure to faithfully represent ‘the self.’ Gender-dysphoric people talk about feeling like a ‘brain in a jar’ or a gender identity stuck in a ‘meat vehicle’ or ‘flesh suit.’ Major surgeries are spoken about with cool disregard, as though they were minor home-remodeling projects.

Take the concept of passing, a concept fundamentally opposed to the experience of becoming or being. Passing is all about how something looks from the outside, not how something feels from the inside. On the altar of passing, clinicians and patients sacrifice health and function. If transition is about becoming your true self, why is there so little focus on being and so much focus on appearing, seeming, passing, and pretending? Why edit the past, rather than own it? Why cut out organs and discipline natural gestures? No, something else is going on here: the pathological exercise of control over a body alienated from the self.

But there’s always more to say about it.

These behaviors—self-starvation, bingeing and purging, cutting, transgender identification—often appear to be an extreme response to objectification and pressures on young women to discipline their bodies and selves: from ‘shape wear’ and other constricting clothing to dieting to plastic surgery. In Reviving Ophelia: Saving the Selves of Adolescent Girls, Mary Pipher and Sara Pipher Gilliam observe that such forms of self-harm can be seen as a “concrete interpretation of our culture’s injunction to young women to carve themselves into culturally acceptable pieces:

As a metaphorical statement, self-harm could be interpreted as an act of submission: ‘I will do what the culture tells me to do’; an act of protest: ‘I will go to even greater extremes than the culture asks me to’; a cry for help: “Stop me from hurting myself in the ways that the culture encourages”; or an effort to regain control: ‘I will hurt myself more than the culture can hurt me.’

Writing of starving martyr-saints and their secular sisters, Hilary Mantel observed that:

The world gets harder and harder. There’s no pleasing it. No wonder some girls want out… It is possible that there is a certain personality structure which has always been problematical for women…

… Anorexia itself seems like mad behavior, but I don’t think it is madness. It is a way of shrinking back, of reserving, preserving the self, fighting free of sexual and emotional entanglements.

Cynthia Cruz writes about her experience with anorexia in terms familiar to gender-dysphoric females, especially girls who attempt to opt out by identifying as nonbinary:

My desire for a non-gendered body was a wish to… be able to return to a time when I had what I experienced as a pre-gendered body. At the same time as I longed for this pre-gendered body, however, I wanted to inhabit the “nothing” of the in-between, the No of gendered being… I wanted to exist outside of, or between, those states of being.

Like trans identification, eating disorders and self harm sweep through social networks. Well-intentioned efforts to raise awareness about these conditions—in the classroom or through the media—may spread the contagion by popularizing templates for young women to understand and express distress, and outline action steps for distressed girls to undertake. Research documents a “near-perfect link” between media exposure and eating disorders like anorexia and bulimia. We see something similar happening with media coverage of trans issues and referrals to youth gender clinics, but few want to talk about the relationship between media consumption (in the case of trans: media celebration), behavior, and identity.

There are other links too many are failing to recognize. Medical professionals have long recognized that peer-support groups can unintentionally fuel disordered eating and spread harmful behaviors. Clinicians often police patients’ speech in group-therapy settings, forbidding “numbers talk” and cutting off discussion of the emotions that drive disordered eating. Medical providers discourage anorexic patients from focusing too much on food or crafting elaborate rituals around eating, and often track disordered eating behaviors through multiple iterations, as patients ‘move on’ from anorexia to fasting for religious purposes or the adoption of restrictive diets like veganism or ‘clean’ eating.

But when an eating-disordered patient comes out as trans, everything clinicians know about how harmful behaviors and identifications spread goes out the window. Suddenly, negative self-talk in group-therapy sessions is OK—as long as the patient says she hates her breasts and hips because she’s not a girl or a woman at all. She’s offered breast binders, even top surgery, to ‘affirm’ her new identity. Her eating disorder suddenly makes sense—she was uncomfortable with her developing body because she was developing the wrong kind of body altogether—and her struggles with weight loss and restriction take a backseat. Suppressing her female form goes from a recognized pathology to a ‘gender embodiment goal.’

And here we can see how the moral imperatives that cluster around trans identities are clouding clinical judgment when it comes to understanding and treating eating disorders themselves.

Last month, at the World Professional Association for Transgender Health, in a session on ‘Multidisciplinary Care for Transgender Teens and Young Adults With Eating Disorders,’ researchers lost the plot on anorexia. ‘Trans and nonbinary’ teens with anorexia are “less likely to express body image disturbance” than their fellow anorexics, researchers reported—yet patients believe they shouldn’t have breasts and hips because they’re not female? Researchers talked about how the return of menstruation is usually regarded as a sign of recovery—but not for ‘trans’ patients, whose periods must be abolished by other means. Anorexia can no longer be understood as a disorder about control—it must become a “reversible brain-based illness of rigidity” instead—because then transgender identification might be about control. Researchers reported an “explosion” in eating disorders among teenage patients since the onset of the pandemic—yet the spike in trans identification over the same time period of isolation, anxiety, and loss of control is of no possible interest. Trans indoctrination now threatens research, understanding, and treatment for serious eating disorders.

One young woman—who had been institutionalized multiple times for anorexia before the age of 17 and subsequently adopted a transgender identity—observed that her medical providers overlooked her history of disordered eating and body image in their rush to validate her new identity by prescribing testosterone and removing her breasts, uterus, and ovaries:

How therapists didn’t see the connection between my background and my dysphoria is beyond me. Instead it got explained a different way: that I used to be anorexic to deal with dysphoria. Starving to get rid of curves to be less feminine. But you know what? That is SO goddamn common for anorexic women regardless of gender identity incongruence. Back then half of the girls in my therapy group had feelings along the lines of… hating puberty. Not wanting to grow up into women. Hating their breasts. It horrifies me to think that girls with the same feelings get diagnosed with “won’t ever accept their body”-syndrome now.

Is it really a mystery why, for many patients, eating disorders go hand in hand with gender dysphoria and transgender identification?


In future posts, I plan to return to the subject of eating disorders and trans identification, including the role online communities play and what treatment and recovery for each looks like under current clinical approaches.