Do eating disorder treatment outcomes differ between transgender, gender diverse and cisgender adolescents?

Most analysis on eating problems (EDs) amongst adolescents has targeted on cisgender people, whose gender identification aligns with their beginning task (Mensinger et al., 2020; Riddle et al., 2024). Limited analysis has examined non-binary and transgender or gender diverse (TGD) adolescents, leading to a scarcity of ED-related data and interventions tailor-made to those teams.

Researchers more and more recognise that conventional ED remedies might not deal with TGD people’ distinctive experiences, resembling increased prevalence of comorbid psychological well being situations (Becerra-Culqui et al., 2018) and points with body-positive approaches, which can heighten gender dysphoria amongst TGD youth, slightly than enhancing physique acceptance (Duffy et al., 2016; Hartman-Munick et al., 2021). Without additional analysis, it’s inappropriate to imagine remedies efficient for cisgender sufferers might be equally efficient for TGD people.

To deal with this hole, Riddle et al. (2024) in contrast ED symptom severity, melancholy, suicidality, and nervousness between cisgender and TGD adolescents at admission and discharge from increased ranges of care (HLOC) ED treatment.

Methods

This retrospective cohort examine recruited adolescents (<18 years) admitted to a better ranges of care (HLOC) eating problems (ED) multi-centre within the US between August 2020 and June 2022. All contributors met DSM-5 ED standards, decided by semi-structured interviews with licensed psychological well being professionals.

The following outcomes have been measured at admission and discharge:

• Eating problems signs (EDE-Q)
• Depression severity and suicidality (PHQ-9)
• Anxiety signs (GAD-7)

Changes in ED signs, melancholy, suicidality, and nervousness have been analysed utilizing paired samples t-tests with Cohen’s d calculations, adopted by logistic regressions utilizing odds ratios (ORs) and sensitivity analyses.

Results

Out of 1,444 people, 617 accomplished each admission and discharge measures: 573 (92.9%) have been cisgender (84.4% feminine) and 44 (7.1%) have been TGD (28 non-binary, 15 trans-male, 1 trans-female).

Main findings

• ED signs improved considerably following interventions (cisgender: t = 18.84, p < .001, d = .79; TGD: t = 6.50, p < .001, d = .98), with no vital variations in cisgender and TGD particular person’s ranges at admission (p = .09) or discharge (p = .48).
• Depressive signs decreased considerably following interventions (cisgender: t = 13.60, p < .001, d = .57; TGD: t = 5.29, p < .001, d = .80) to an identical extent for each teams (unadjusted: p = .42, adjusted: p = .29), though TGD had increased melancholy at admission (p < .001) and discharge (p < .01).
• Suicidality decreased considerably following interventions, (cisgender: t = 4.00, p < .001, d = .17; TGD: t = 4.70, p < .001, d = .71) to an identical extent for each teams (unadjusted: p = .93; adjusted: p = .80), though TGD adolescents had increased suicidality at admission (p < .001) and discharge (p = .02).
• Anxiety signs decreased considerably following interventions (cisgender: t = 10.01, p < .001, d = .42; TGD: t = 2.68, p = .01, d = .40) to an identical extent for each teams (unadjusted: p = .14; adjusted: p = .06), though TGD people had increased nervousness at admission (p = .06) and discharge (p = .02).

Sensitivity analyses

Results remained related after excluding 19% (n = 117) of cisgender contributors who have been in inpatient care or had a prognosis of bulimia nervosa.

Conclusions

Contrary to hypotheses, transgender or gender diverse (TGD) adolescents confirmed related eating problems (ED) symptom enhancements to cisgender adolescents, which inserts with grownup findings on this space (Riddle et al., 2022). However, they did have increased nervousness, melancholy, and suicidality scores each earlier than and after the intervention.

This signifies that whereas ED remedies could also be equally efficient for cis and TGD adolescents, TGD adolescents may have continued help post-discharge to deal with extra extreme comorbidities.

Strengths and limitations

Strengths

• Statistical rigor and comparability: Riddle et al. (2024) demonstrated robust statistical rigour with logistic regressions, the place they managed for admission scores, comorbidities, degree of care and intercourse assigned for beginning. This strengthens claims that TGD people profit equally to cisgender people from ED interventions by exhibiting related treatment outcomes regardless of TGD adolescents’ demographic variations.
• Enhanced inside validity: Sensitivity analyses excluded cisgender people in inpatient care or with bulimia nervosa. This bolstered the inner validity of the findings and confirmed that the upper presence of inpatient care and bulimia within the cisgender group didn’t considerably have an effect on treatment outcomes, as outcomes remained in keeping with the complete pattern. This signifies good replicability of the examine findings.

Limitations

• Long-term measures: The absence of long-term follow-up limits understanding of the sustained advantages from HLOC ED treatment, stopping assumptions that long-term treatment results for cisgender adolescents (Fischer et al., 2014) apply to TGD adolescents. A longitudinal comparability is required to verify that cisgender and TGD each present related sustained advantages.
• Causality: As that is an observational examine with a small pattern, replications are wanted to make clear if elevated comorbidities pre-treatment and post-discharge are widespread amongst all TGD people in HLOC ED treatment or simply amongst these referred for treatment within the examine. This would point out whether or not adjunctive help for comorbidities is at all times advisable in care of TGD adolescents, or a consideration solely on this pattern.
• Attrition: Many people with barely totally different admission scores from the analytic pattern additionally didn’t full discharge measures. The medical significance of this distinction is unknown, elevating issues in regards to the replicability and generalisability of the examine’s total findings. Further analysis is required to help that ED interventions equally profit TGD and cisgender adolescents.
• Small pattern dimension and restricted energy: The small TGD pattern dimension limits detection of refined variations and within-group variations (e.g., between non-binary and transgender people), hindering the exploration of variations in treatment outcomes amongst gender-diverse people (Streed Jr et al., 2018). This means the authors can’t present particular steering for the differential treatment concerns within the care of transgender and non-binary adolescent ED sufferers.
• Measurement validity: The measures for suicidality, melancholy, and nervousness used within the examine haven’t been extensively validated for TGD people (Holt et al., 2019; Moyer et al., 2019), elevating issues about their reliability and accuracy in capturing these signs on this inhabitants. This highlights the necessity for additional validation of those measures earlier than they could be used to judge the advantages of ED interventions for TGD adolescents in future analysis.

Implications for apply

Treatment efficacy and adjunctive interventions

• The examine suggests related efficacy of ED remedies throughout cisgender and TGD adolescents. However, sustained elevations in melancholy, nervousness, and suicidality amongst TGD people underscore the necessity for adjunctive interventions tailor-made to deal with TGD’s adolescents distinctive challenges (e.g., gender dysphoria, heightened self-harm and suicidality; Donaldson et al., 2018).
• Adjunctive hormonal treatment might improve ED treatment and profit depressive temper in transgender people, and may very well be worthy of consideration (Riddle & Safer, 2022).
• Adjunctive rest remedy has proven some profit in cisgender ED treatment (McComb & Clopton, 2003), and would possibly convey some advantages for TGD with elevated nervousness, though this requires extra exploration.
• Clinicians might think about screening TGD adolescents for elevated comorbidities, making referrals to related providers (e.g., referring people with excessive melancholy to cognitive behavioural remedy) as a part of discharge care planning.

Longitudinal research and replication

• Longitudinal research with bigger, extra diverse samples are wanted to know the long-term efficacy of ED treatment, and to delineate refined variations in treatment responses between cisgender and TGD adolescents.
• Despite the small pattern dimension on this examine, the authors inspired the evaluation and publication of research with small samples as an method to fight the dearth of literature on this space.

Intersectionality

• It is usually recommended that cultural norms might influence gendered physique beliefs and consequently have an effect on treatment responses (Gordon et al., 2010; Townsend et al., 2012), which warrants additional analysis.
• However, inspecting the interplay between racial and ethnic identification in ED treatment would require bigger, extra diverse samples.

Measurement validity

• Future analysis ought to validate normal measures for TGD people to make sure dependable and correct measurement of symptom severity.
• Including treatment satisfaction and gender dysphoria measures in future analysis might additionally present a extra complete understanding of treatment efficacy resulting from proof that even when consequence measures for TGD and cisgender people could also be related, these teams usually differ when it comes to treatment satisfaction (Hollinsaid et al., 2020).

Assessing gender dysphoria

• Given the interaction between gender dysphoria and ED signs (Duffy et al., 2021), future analysis might additionally discover how gender dysphoria impacts within-group variations between transgender (e.g., on/off hormone substitute drugs) and non-binary adolescents’ ED treatment outcomes.

Statement of pursuits

None.

Links

Primary paper

Riddle, M., Blalock, D. V., Robertson, L., Duffy, A., Le Grange, D., Mehler, P. S.,…Joiner, T. (2024). Comparing eating disorder treatment outcomes of transgender and gender diverse adolescents with these of cisgender adolescents. International Journal of Eating Disorders.

Other references

Becerra-Culqui, T. A., Liu, Y., Nash, R., Cromwell, L., Flanders, W. D., Getahun, D.,…Millman, A. (2018). Mental well being of transgender and gender nonconforming youth in contrast with their friends. Pediatrics, 141(5).

Donaldson, A. A., Hall, A., Neukirch, J., Kasper, V., Simones, S., Gagnon, S.,…Forcier, M. (2018). Multidisciplinary care concerns for gender nonconforming adolescents with eating problems: A case collection. International Journal of Eating Disorders, 51(5), 475-479.

Duffy, M. E., Calzo, J. P., Lopez, E., Silverstein, S., Joiner, T. E., & Gordon, A. R. (2021). Measurement and assemble validity of the Eating Disorder Examination Questionnaire Short Form in a transgender and gender diverse group pattern. Psychological Assessment, 33(5), 459.

Duffy, M. E., Henkel, Ok. E., & Earnshaw, V. A. (2016). Transgender purchasers’ experiences of eating disorder treatment. Journal of LGBT Issues in Counseling, 10(3), 136-149.

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Hartman-Munick, S. M., Silverstein, S., Guss, C. E., Lopez, E., Calzo, J. P., & Gordon, A. R. (2021). Eating disorder screening and treatment experiences in transgender and gender diverse younger adults. Eating Behaviors, 41, 101517.

Hollinsaid, N. L., Weisz, J. R., Chorpita, B. F., Skov, H. E., Price, M. A., & Health, R. N. O. Y. M. (2020). The effectiveness and acceptability of empirically supported remedies in gender minority youth throughout 4 randomized managed trials. Journal of Consulting and Clinical Psychology, 88(12), 1053.

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Moyer, D. N., Connelly, Ok. J., & Holley, A. L. (2019). Using the PHQ-9 and GAD-7 to display for acute misery in transgender youth: findings from a pediatric endocrinology clinic. Journal of Pediatric Endocrinology and Metabolism, 32(1), 71-74.

Riddle, M. C., Robertson, L., Blalock, D. V., Duffy, A., Le Grange, D., Mehler, P. S.,…Joiner, T. (2022). Comparing eating disorder treatment outcomes of transgender and nonbinary people with cisgender people. International Journal of Eating Disorders, 55(11), 1532-1540.

Riddle, M. C., & Safer, J. D. (2022). Medical concerns within the care of transgender and gender diverse sufferers with eating problems. Journal of Eating Disorders, 10(1), 178.

Streed Jr, C. G., McCarthy, E. P., & Haas, J. S. (2018). Self-reported bodily and psychological well being of gender nonconforming transgender adults within the United States. LGBT Health, 5(7), 443-448.

Townsend, L., Gearing, R. E., & Polyanskaya, O. (2012). Influence of well being beliefs and stigma on selecting web help teams over formal psychological well being providers. Psychiatric Services, 63(4), 370-376.

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