Gender dysphoria and eating disorders

[AppropriateAdult]

DH and I are both GPs, working in different practices. We were chatting the other night about various issues, and he mentioned that he’d noticed a decrease in the number of young people presenting with eating disorders over the last few years. I hadn’t really noticed it myself, but when I thought about it I realise my practice is the same - it’s actually been quite a while since I’ve seen a teenager coming in for the first time with symptoms of anorexia or bulimia.

And then I started musing about possible reasons for this, and I wondered - given the massive increase in supposed gender dysphoria among teenage girls particularly - whether the distress and anxiety that would at one time have manifested as anorexia nervosa is now in some cases being expressed as gender dysphoria? Especially given the element of social contagion that seems to exist with GD.

It’s just a theory, but I’d be interested to know if anyone else working in healthcare has noticed anything similar, or indeed any parents of teenagers?

Numbers of teens with eating disorders has rocketed recently so no, but I agree there is a lot of cross over between the two

That is such a helpful observation that I wonder if there's a way of wording it and asking for comment on a relevant WhatsApp or similar forum?

Would any of the NHS dashboards and data collections overtly or indirectly capture primary care consultations about eating disorders in this age group?

This is what happens when you rely on anecdotal evidence rather than real data. Eating disorders have skyrocketed recently, largely due to lockdown. And there does seem to be a link between trans people and eating disorders. Here's an article talking about it eatingdisorders.dukehealth.org/education/resources/gender-dysphoria-and-eating-disorders
TLDR; trans people have a higher rate of eating disorders, likely because they share a commonality of wanting one's body to look a particular way, and this can help be addressed by destigmatising both eating disorders and transgender

😀I wasn't 'relying' on anecdotal evidence for anything, so please calm down. I was musing on a phenomenon I'd noticed and whether it had any wider implications. I'm not in the UK (though not far away either geographically or culturally), and so far I'm not aware of data showing a rise in incidence of EDs in my country, but I'll dig a little deeper.
Obviously lockdown has skewed figures for all sorts of conditions wildly; it will probably take several years to discern true patterns from all the noise that Covid has created.

I think there's definitely a link. I have a friend in their 30's who has struggled with eating disorders and self harming since their teens. Now decided they are trans and started on T and been referred for 'top surgery'. I have no faith at all that it will make them happier (I hope I'm wrong), think it's just all part of the same cycle. I'm not medically trained but it just seems obvious to me.

I wonder if it's the same person I know. Struggled with anorexia throughout her 20s, finally seemed to have left it behind but is now identifying as trans and taking testosterone. You don't have to be Freud to see how both conditions involve fleeing a normal adult female body.

Disclaimer - I'm not a medic.

I have a friend whose daughter is in the worst throes of anorexia and at risk of hospitalisation so at the moment it feels very immediate and I understand that ED numbers are up if anything. However, I also know 3 female teenagers who are transitioning this year, which was of course something that I never previously saw even once in a lifetime of friendships with women and girls.

Transitioning offers something to people in a highly gendered world - and that high level of gender visibility and the idea of the physically malleable self in the media and culture is a Gen X product which younger people are processing in their own way. Eating disorders do seem different to me though of course there's a crossover where self harm sits.

I'd also wonder if maybe some of the eating disorders are being over-shadowed by gender diagnosis in some patients?

The form anorexia takes is largely culturally determined so it would be quite possible that it is changing over time.