“In some cases, disordered eating may initially serve a purpose in shaping the body to become more congruent with one’s gender identity,” says Rebecca Boswell, PhD, Supervising Psychologist at Penn Medicine Princeton Center for Eating Disorders. “But an eating disorder can quickly take control. It’s not just about appearance – eating disorders can be a way to cope with the trauma of your identity not meeting societal gender-related expectations.”
There is substantial evidence that gender-diverse patients perceive discrimination in the health care environment, including experiences of explicit and implicit bias by providers. Negative experiences in health care settings can contribute to gender minority stress and are linked with delays in seeking care and negative health outcomes.
“As health care providers, we can help break this cycle by providing an environment that adapts to the needs of gender-diverse patients,” adds Dr. Boswell. “Affirming a person’s identity is an important aspect of helping them feel safe.”
The team at Princeton Center for Eating Disorders is embracing strategies to create a more gender-inclusive environment for care, including the following.
- Using chosen names and pronouns. This may seem basic, but it can be a lifesaving intervention, according to Dr. Boswell. The use of chosen names in transgender youth is linked to a reduction in depression, anxiety, suicidal ideation, and suicidal behavior. It communicates that providers see, value, and respect a patient’s identity.
- Accommodating gender-affirming identity materials. If patients use gender-affirming tools such as binders, they can do so during their inpatient stay. Allowing patients to keep these materials in the hospital helps them express who they are.
- Offering gender-affirming medical expertise. Because Princeton Center for Eating Disorders is housed in Penn Medicine Princeton Medical Center, patients have the benefit of consultations with multidisciplinary specialists. For example, interventions like hormone therapy can be continued and gender-affirming medical/surgical referrals can be provided.
- Following the patient’s lead regarding gender and care. A possible goal of treatment is to reach medical stability so that patients can choose to engage in additional gender-affirming care if desired, according to Dr. Boswell. But not all patients want their eating disorders care centered around their gender identity, so honoring boundaries is also important.
- Providing gender-related education and training. These efforts can improve cultural competency and provide a deeper understanding of gender-diverse patients. Princeton Center for Eating Disorders has trained all providers in gender-informed care and policies, incorporates this education into staff orientation, and provides ongoing educational opportunities to ensure an inclusive clinical environment. To enhance knowledge for the behavioral health community, a number of these presentations will be available for free this fall and will feature continuing education credits.
“Most transgender and gender-diverse patients have faced rejection and bias, and anything we can do to provide a supportive environment is worth the effort,” adds Dr. Boswell. “These individuals are the experts on who they are, and we take their lead on discussions around gender while promoting acceptance and honoring their identity.”
| 8 tips for communicating with patients in a gender-affirming way | |
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1. Introduce yourself using your pronouns 2. Ask how a person would like to be addressed 3. Use terms that patients use to describe themselves 4. Ask respectfully about legal names if they do not match your records 5. Document sex as assigned male/female at birth |
6. Use the patient's chosen name, gender, and pronouns in the chart Help colleagues understand chosen names and correct pronoun usage 7. Respectfully correct others when needed 8. Apologize if you make a mistake |
| Research estimates that: | ||
| Up to 18% of transgender and gender-diverse individuals have eating disorders.1 | 75% of LGBTQ youth report experiences of discrimination at least once in their lifetime.2 | 42% of LGBTQ youth and more than half of transgender and nonbinary youth seriously considered attempting suicide in the prior year.2 |
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A new JAMA study3 found that gender-affirming care for teens ages 13-18 reduced their rate of moderate to severe depression by 60% and their odds of suicidality by 73% over a 12-month period. 1. Coelho et al, Curr Psychiatry Rep, 2019.
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