Introduction
Eating disorders are complex illnesses, and their exact causes cannot always be determined. Nowadays, transgender individuals have a much higher incidence of these disorders than cisgender individuals (Nagata et al., 2020). It is already known that this problem is often related to a person’s dissatisfaction with their body and can be triggered by diet or disrupted eating patterns during hormone replacement therapy.
The potential dependence of eating disorders on a person’s general psychological state after making the decision to change sex has also been determined. One of the risk factors is the influence of the environment, and in some cases, it can negatively affect the mental state of a transgender person (Testa et al., 2017). Unfortunately, there is still the problem of discrimination against people who are different from the majority in society, and this issue is not sufficiently disclosed in the existing research on the theme.
Problem Statement and Rationale
However, the current understanding of the problem does not sufficiently identify common factors and dependencies. There is a lack of comprehensive information due to the reluctance of many transgender people to disclose such personal information as well (Gordon et al., 2021). To create the most accurate analysis of the causes of eating disorders, more pertinent data and statistics regarding the relationship between issues and psychological causes are required (Testa et al., 2017). Moreover, a deeper analysis of all possible risk factors connected to this situation should be conducted.
This study will contribute to filling in the gaps in knowledge about the causes of eating disorders in transgender people. Furthermore, one of the study’s primary goals is to supplement existing methods for dealing with the onset of the problem. Equally important is the expansion of information on early detection of such a disorder and on preventive work with transgender people.
Purpose
Based on the most common risk variables, this study attempts to develop a novel way to assist lower the prevalence of eating disorders among transgender individuals. It might involve guidance on modifying eating habits in addition to suggestions for steering clear of dangerous circumstances that might exacerbate the problem. The study will likewise offer solutions for professionals who help these patients psychologically or physiologically.
Research Questions
The main issue that prompted the need for the study is the significant number of transgender people who suffer from eating disorders. Some sources claim that the prevalence of these situations among them is around 15%, which is disproportionately higher than that of cisgender people (Nagata et al., 2020). This argument was used to establish the primary research questions:
- Which are the main risk factors for eating disorders among people who identify as transgender?
- How to detect the presence of these factors in time before the onset of the disease?
- What methods can be used to prevent the occurrence of each of these factors, or at least to minimize their impact if they are already present?
The hypothesis of this study is an existence of a direct link between the occurrence of eating disorders and reasons related to the patient’s dissatisfaction with their body or discrimination. According to this idea, there is a clear relationship between the risk factors and the disease, and if they are completely or partially removed, the whole condition should improve.
Literature Review
For a serious and objective approach to the purpose of the study, sources related to the topic of eating disorders in transgender people were examined. Currently, society is very much evolving in terms of tolerance and attention to minority issues, including gender-specific groups. Due to this factor, a significant part of the research has appeared in the past few years, including work on identifying causes and attempting to address eating disorders. Most of the material studied focuses on young people as the more problematic stratum in percentage terms. However, papers analyzing other age groups were likewise selected to maximize exposure.
A total of 49 articles were reviewed, including e-journals, books, and journalistic publications in open resources like libraries or news websites. As a result, 12 significant writings were selected, with preference given to peer-reviewed sources to maximize the validity of the conclusions in the analysis. The literature review section compares key components of approaches to the causes, course, and consequences of eating disorders among transgender people.
Eating Disorders in the LGBT Population
The rising prevalence of eating disorders among gay, lesbian, bisexual, and transgender individuals—the majority of which are brought on by stress—is the issue that all of the chosen sources address. Some papers focus exclusively on transgender people having the highest eating disorder rate among the entire LGBT community (Bell et al., 2018; Parker & Harriger, 2020; Uniacke et al., 2021). Eating disorders refer to a feature of behavior change in which a person disrupts or interrupts standard eating behaviors while experiencing related negative emotions or feelings. Such disorders can have a severe impact on a person’s social, psychological, or physical state and functioning and have unpredictable negative consequences.
Key Concepts, Theories, and Studies
Most authors agree on the exact central definition of causes. For example, Bell et al. (2018) state that most diagnostic findings in eating disorders demonstrate concern about shape and weight as the underlying cause. Accordingly, bouts of overeating or malnutrition, excessively rigid diets, starvation, or insufficient nutrient intake might result from a self-esteem issue.
Such disorders raise a further problem – compensatory patterns in the behavior. Many authors include in these concepts the abuse of diuretics, laxatives, and other medications or harmful dietary supplements, self-induced vomiting, or compensatory physical overload with general frailty (Bell et al., 2018; Nagata et al., 2020; Testa et al., 2017). The occurrence of bulimia nervosa or anorexia nervosa has been reported in a large number of cases in transgender men and women (Duffy et al., 2019; Gordon et al., 2021). The rate of such disorders fluctuates in the LGBT population, but it is immeasurably higher than in the cisgender population.
The main theories are the determination of the underlying cause, and here, opinions are somewhat divided. According to Nagata and Murray et al. (2020), a key role in the development of the described conditions and other eating disorders is played by dissatisfaction with one’s body, a failure to conform to one’s ideas about its shape. Many disorders can be caused by the pursuit of ideal images of gender identity or the desire to reduce the association with the sex assigned at birth, for example, a decrease in the expressiveness of the secondary sex characteristics (Nagata et al., 2020). Separating disordered eating from the particular antecedent of a gender-oriented eating disorder is another issue.
The second leading theory, according to Nowaskie, can be blamed on sociocultural pressures of society in addition to gender dysphoria (Nowaskie et al., 2021). This idea occurs and is highlighted by many other sources (Bell et al., 2018; Coelho et al., 2019; Gordon et al., 2021). The implication is the negative influence of others on the psychological state of the transgender person. This influence can include bullying as well as denial and rejection in society, not necessarily experienced personally (Bell et al., 2018). Furthermore, sociocultural pressure can include stereotyped images of gender identity, through which this theory connects and interacts with the first theory.
Key studies were conducted at different times on multi-age samples, most of which had insufficiently large numbers of representatives of the transgender community. Thus, in almost all of the sources studied, one of the problems is the lack of clinical and statistical data (Parker & Harriger, 2020). This problem will be discussed in more detail in the following sections. In most studies and surveys, the basis was an eating disorder research questionnaire, the original of which is designed exclusively for cisgender people (Nagata et al., 2020).
Through the analysis of several sources, several significant observational findings can be highlighted. According to the statistics, the average rates of dietary restriction are higher among transgender women than among transgender men of the same age categories (Nagata et al., 2020). Accordingly, they are less likely to engage in compensatory behaviors such purposeful vomiting or physical overload (Hartman-Munick et al., 2021; Parker & Harriger, 2020; Uniacke et al., 2021). However, the difference in observational findings varies from study to study within the chosen population itself and is considerable when compared to other members of the LGBT population.
Moreover, given the extensive number of studies conducted on young transgender persons, the second theory about sociocultural pressures highlighted becomes apparent. Adolescents are disproportionately more likely to experience bullying and intolerant environments than older members of the survey groups (Coelho et al., 2019). This finding draws attention to the importance of finding not only medical and psychological means to find the best resolution to the problem but to involve the social, humanitarian, and educational components of society as well.
Proposed Study’s Position on Debatable Evidence
Controversial evidence includes the heterogeneity of the scoring systems used by researchers. This study assumes that only through the unification of research methods and questionnaires is it possible to obtain the most accurate data. Accordingly, the results will be the most reliable when analyzing such data. The use of questionnaires for cisgender patients cannot be an entirely correct step (Nagata et al., 2020). Moreover, changes in the details of such questionnaires must be forced at the state legislative level in order to get results.
As for the age limits, there is enough ambiguity in the process of their definition as well. The claims of Avila et al. and Coelho et al. (2019), whose works focus primarily on transgender youth, are contentious. According to their version, many problems are shaded brighter and more prominent precisely in samples of people under 20-22 years of age (Avila et al., 2019; Coelho et al., 2019). But it’s important to pay attention to the older generation’s psychological decline and possible eating problems that may follow (Bell et al., 2018). The midlife crisis, aging psychic issues, and related societal problems for transgender people are no less critical statistically than levels of bullying among transgender youth.
Controversies Surrounding the Research
The prominent and most notable controversy is the inconsistency of research findings. For instance, the final results of several surveys with similar technique and age selection may differ significantly. For example, the Bell et al. (2018) surveys suggest a significant difference in EDE-Q scores between transgender men and women. In contrast, in the various analyses, this distinction is much smaller (Nagata et al., 2020). It is highly possible, in this case, that this situation may occur due to a general lack of data.
In addition, the same need for further research is repeated in virtually all of the sources that have been studied. It is crucial to develop specific methods and tools of analysis for diagnosing eating behavior disorders and identifying related and following problems (Coelho et al., 2019). Furthermore, two countervailing views can be identified in the discussion of the issue: focusing on finding the best method of prevention or on the timely identification of symptoms and their treatment together with the consequences (Hartman-Munick et al., 2021; Parker & Harriger, 2020). The best solution in this situation can be considered to be combining such developments to eliminate the situation as a whole.
Gaps in the Existing Knowledge
Two major gaps can be found in the existing data today, and methods for closing them can be proposed. The first of these techniques relates specifically to the lack of data and the ensuing interconnected problems of validity, estimation, and the overall meaning of the analysis (Uniacke et al., 2021). At the same time, the situation is possibly aggravated by the psychological state of those observed, which, in most cases, is corrupted by sociocultural and other pressures (Bell et al., 2018; Parker & Harriger, 2020). When completing information, people with a defeatist attitude may successfully conceal some information or provide untruthful data for fear of being disrespected.
Among other missing knowledge, researchers cannot have information about what percentage of all transgender people can hide the fact that they have eating problems and may end up at the doctor’s office already in poor condition with severe health issues. In addition, specialists do not always monitor hormone therapy, and a large percentage of transgender people are not consulted by professionals (Parker & Harriger, 2020). They can cause a significant statistical number of illnesses in the transgender community, such as eating disorders, which are prevalent among LGBT individuals, and numerous other possible health issues.
The second fact of the data absence relates to the researchers’ focus on specifying research findings rather than seeking knowledge about solutions to eating disorders among transgender people. The process of gathering information itself needs to be anonymized as much as possible in order to create as large a sample as possible and offer a workable solution to the problem (Nagata et al., 2020). So far, unfortunately, the majority of researchers have recommended pinpointing psychological and physiological help (Parker & Harriger, 2020). However, an understanding of the need for some specific action to reduce the overall percentage of such disorders in society is needed.
Methodology
This methodology will be created with future qualitative and quantitative designs in mind to achieve the study’s goals. The use of quantitative design will be done solely to collect and evaluate initial data for the qualitative study (Kumar, 2020). Because a large amount of information is needed to evaluate and draw conclusions, partial use of quantitative methodology is acceptable. The main research design, in this case, will be descriptive.
Research Design
Due to the peculiarity of this method, the direct level of dependence of eating disorders in transgender members of society on previously determining factors will be analyzed. This research design extensively uses the method of information collection. The main concern of qualitative research is the question “how?” (Pandey & Pandey, 2021). In asking about ways and options for reducing the number of members with an eating disorder in the selected population, the conclusions and set of recommendations will be the answer to the research question and its primary outcome.
The study’s theoretical model will evolve in analyzing, describing, and revising the results of previous research and other sources. It will require a maximum amount of data and a comparison of all the statistical research that will be found to form the outcome (Kumar, 2020). For the time being, this model suggests an essential and most crucial proportional relationship between the onset of an eating disorder and an individual’s psychologically distressed state. The quantitative data that will be collected includes the number of actual transgender individuals with eating disorders and the total number of complaints about psychological well-being among transgender people for comparison.
Sampling
Natural observation and survey results significantly impact determining the overall trend of the problem and can provide perspectives on methods of countering it. Since the percentage of transgender people in the population and even among the LGBT community is relatively small, the entire relevant population within the United States will be evaluated. Because of the dispersion of the test population across the chosen region, and even more so the percentages, equal numbers of transgender men and transgender women will be chosen.
When compiling statistics for this sample, the method of dispersion over the selected population will be utilized. It will imply a regional increase in the variance of those tested to achieve the most reliable analysis results (Fu et al., 2020). Accordingly, the sampling method is implied to be systematic since, for the other methods, the density of the problem and the population being evaluated itself is not high enough. Local and online LGBT communities will be contacted with a request to fill out a form in case they agree. The purpose of the study will be explained to them in order to improve communication, and anonymity will be granted.
Instruments
The research tools in the assessment phase will be various methods of gathering information for analysis. In this case, this will include both uniform methods for those suffering from eating disorders and those explicitly aimed at minorities. Eating Disorder Examination Questionnaire (EDE-Q), SCOFF and patient behior observation checklist will be used.
Eating Disorder Examination Questionnaire (EDE-Q)
The eating disorder questionnaire is the most widespread and standardized method of determining the presence and extent of an eating disorder. It is a set of twenty-eight questions, most designed to determine the severity of the disorder, associated complications, and the patient’s psychological state (Linsenmeyer et al., 2020). The analysis uses four essential rating scales: weight anxiety, form anxiety, eating anxiety, and restraint.
The main disadvantage is the lack of additional categorization of the recipient as a member of the LGBT community. Accordingly, the data from this questionnaire are relevant to the target population only if the recipient voluntarily provides this kind of information (Bultynck et al., 2020). However, since this questionnaire is the most common, the use of its data will be an important part of the study.
SCOFF and SANSI
Further screening tools exist in a gender-non-specific format, and the connection to transgender individuals is possible due to patient medical data. Sick, Control, One, Fat, Food (SCOFF) is one such tool, the results of which will be used in the study. The St. Andrews Nutrition Screening Instrument (SANSI) is designed for psychiatric patient populations. However, with the necessary correlation, in this study it will contribute to determining the level of dependence on psychological and eating disorders in transgender individuals.
Patient Behavior Observation
This instrument would consist of a compilation of behavioral data from patients in the study group with confirmed eating disorder diagnoses. It may include statistical data from medical institutions and specialist evaluations (Pandey & Pandey, 2021). Ultimately, it will facilitate identification with specific causes and provide specific suggestions for remediation.
Data Collection and Analysis Procedures
Data will be collected by searching for the most relevant and expanded statistical data possible. It will include various sources and distribute information according to the interest criteria. The investigation of the main risk factors and possible preonset for them, as well as methods of prevention, will be conducted. Multivariate regression analysis will be used in the analysis, as the most appropriate in this case, where the dependent variables will include risk factors and prevention possibilities, while all associated features and conditions will be independent variables. As a statistical environment for the analysis, it is recommended that the software product SASS be used as one of the most powerful and widespread.
Practical Considerations
In addition to the lack of data, which will be made up for in the analysis process, the ethical side of the issue is a limitation. It may negatively affect the quality and quantity of data but will be screened out through painstaking analysis of the information, if possible. Due to that reason, only willing participants will be questioned anonymously.
Implications and Contributions to Knowledge
This research will be of great importance not only to people from the transgender community but also to the entire scientific community. There is often a lack of knowledge in modern medicine and psychology, especially when the information is related to minorities (Parker & Harriger, 2020). Sexual minorities and their problems have been ignored until recently, along with ethnic minorities. Consequently, the entire body of information available today is tied either to generally accepted medical research or to exclusively observational or statistical estimates of the incidence of eating disorders among the LGBT community.
Undoubtedly, due to the lack of information and knowledge assessed above in terms of determining the causes and countermeasures of eating disorders among transgender people, this research will have a significant role to play. For a society that tends to underestimate gender identity and related issues, focusing on the issue will promote diversity, tolerance, and acceptance of others. Especially when one considers the vulnerability of the category of people under study to eating disorders, one of the causes of which is societal rejection and ongoing discrimination. Below are the practical and theoretical implications of this work and the expected outcome.
Practical Implications
The study should help create the necessary methodology to work with the prevention and treatment of eating disorders in transgender people. Identifying the specific causes of the problem will provide a chance to increase the diagnostic rate at an earlier stage (Nowaskie et al., 2021). In addition, the results of the ongoing work will include the necessary practical solutions and recommendations for their implementation. Consequently, there is an opportunity to identify the specific practical benefits and applications this research can provide.
- The study’s results could influence certain changes in the methods, forms, and programs of intervention in treatment and prevention. Based on the findings, therapists, endocrinologists, and psychotherapists will be able to adjust their interventions to most effectively affect the individual and combat the disorder. In addition, the proposed preventive measures can be used to eliminate eating disorders from the list of emerging conditions in transgender people as much as possible.
- Subsequent research can flesh out the issues and provide appropriate solutions to any additional problems that may arise in practice. As with any scientific work, the optimal solution may not always be found and articulated in the primary study, though it is aspired to be.
- The results of the study will help practitioners look at their workplace in a new way and encourage them to develop individualized, patient-specific assessments. Some practitioners do not fully understand the importance of perceiving patients by their psychological gender and often ignore this issue, thus increasing the likelihood of patient secrecy and uncommunicative behavior. Among other things, this study should combat this problem and draw the attention of everyone involved in treatment.
- Findings will improve the process of prevention, treatment, and psychological approach to unconventional patients. Depending on the organizational feedback and the significance of the study, there will be a chance for behavioral policy changes with all transgender people in the eating disorder case. Among the proposed will be both a change in the format of the universal questionnaires and maximum anonymization prior to the direct appointment with the physician, which will encourage patient candor.
- Moreover, in practical terms, there will be an increase in benefits not only for medical personnel but likewise for transgender patients themselves. By introducing changes to the questionnaire, they will be able to interact with fewer medical professionals, which will significantly reduce the risk of discrimination or misinterpretation of the information provided.
- As a result of the study, it will again be proposed to introduce changes in the regular and routine examinations of patients with eating disorders. It would help to eliminate cases where even non-transgender people without discrimination feel inferior because of the need to disclose personal information.
- One of the main practical applications would be the other boost this study would give to physicians and preceptors in the field. If they consider all the mentioned facts and appreciate the importance of working with transgender people as unique patients, given their vulnerability, the result will be exceptionally positive.
Theoretical Implications
One of the purposes of the study in theoretical terms is to draw attention to the problem. The analysis is not intended to fundamentally change existing assumptions. Additional developments based on this work are possible in the future to specify methods or to improve the results and conclusions (Nowaskie et al., 2021). Further studies of this issue should be aimed at observing the dynamics of change in the implementation of the new methodology and its adjustment, if necessary.
Once again, in terms of research application, the main goal is clearly to draw special attention to the problem and to encourage additional research into the question by all who wish to do so. The analysis is not intended to change any existing assertions globally but will signal the priority of this research in the first place. Certainly, painstaking practical work is needed to develop complete working methods in practice, and more research may be needed. In addition, further study of the issue will be able to build on the decisions made after this study and their results to refine the solutions reached and track the dynamic effectiveness. In addition, the theoretical significance will include the following:
- A slight change in the theoretical framework and assumptions related to patient feedback. This change will help the healthcare industry, professionals, and researchers to consider transgender community members specifically in further research and the development of preventive or patient interaction techniques.
- This work is unlikely to strengthen any models or theories because there still needs to be more unambiguous ideas or generalized assumptions about this issue in the scientific community. The goal of the theory assessment will be to develop a new and sustained understanding of the need to take into account all of the characteristics of minority patients, especially transgender patients, when analyzing or evaluating further theoretical developments.
- A modified theory will be able to provide evident and maximal possible risks and causes of eating disorders among transgender people in the available sample. Moreover, this work and an updated theory of the root cause view can indirectly help investigate similar problems in other sexual minorities.
Conclusion
In conclusion, a reiteration of all points of maximum possible importance, having a direct connection with the work results, its purpose, and the final result, is proposed. Undoubtedly, the necessity of the study will be stressed, and all the research questions will be answered. Among other things, the main factors of transgender people’s incidence of an eating disorder will be identified and restructured according to importance and frequency of occurrence. Opportunities for early detection of these factors will be considered, and methods for counteracting them will be suggested. In addition, there are a number of findings that will be part of the study’s conclusions:
- The study will be conducted because the problem of eating disorders among LGBT minorities is a large and growing problem.
- More attention is and will be further underlined to be paid to the psychological and physical health of the least protected communities.
- The specificity of the research is to unambiguously identify risk factors and causes of problems in order to eliminate them and to implement prevention action possibilities further.
- The chosen research design is descriptive because it is optimal in the case of this study due to the analysis of statistical data and description of the results obtained.
- The methods proposed to address potential risk factors, treat the disease itself, and deal with the consequences are relevant and will be optimal for the entire population of transgender individuals.
- The work will fit perfectly with the broader spectrum of work and research on the psychological and physiological problems of the LGBT community.
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