Eating disorders as a way of coping: study hears from 260 neurodivergent trans and gender diverse adults

A new study in the Journal of Eating Disorders has asked neurodivergent trans and gender diverse adults, in their own words, what they think contributed to their eating disorder.

The researchers start from two known patterns. Trans and gender diverse people have higher rates of eating disorders than cisgender people, and they are also more likely to be autistic and/or have ADHD. There has been little qualitative research on how these parts of a person’s life fit together, and this study set out to fill that gap.

What the researchers did

The team ran an online survey with 260 trans and gender diverse adults in the UK. Everyone taking part was autistic, had ADHD, or both, and had current or past experience of an eating disorder. About three in four (75.4%) were assigned female at birth, and the average age was 28.

Participants answered two open-ended questions about what they felt had contributed to their eating disorder. The researchers used reflexive thematic analysis. This is a common qualitative method where researchers read responses closely and group them into shared themes, while being open about how their own perspective shapes that process.

What they found

The researchers drew one overall theme from the answers: eating disorders worked as a way of managing both internal experiences and external challenges. Within that, they described four strands, which can overlap:

• Gaining control in an overwhelming world
• Living in a body that does not reflect your gender
• Negotiating identity and belonging in a society built around cisgender and neurotypical norms
• Managing how your body looks for safety

In their plain English summary, the authors say participants described their eating disorder as a way of coping with challenges they faced, some of them linked to their gender diversity, autism and/or ADHD. These included sensory overwhelm, discomfort in their body, struggling to fit other people’s expectations, feeling isolated and different, worries about being judged or targeted, and feeling unsafe.

The authors say the findings show how varied people’s experiences are. They place eating disorders within a wider mix of social, cultural and relationship pressures that affect both distress and people’s ability to cope with it. They also note there is no single reason why trans and gender diverse people develop eating disorders, and that support and treatment need to take account of people’s identities, life experiences and neurodivergent characteristics.

This framing matters. As well as the part played by autism and ADHD, participants’ accounts point to how a cisnormative and neuronormative world (one that assumes everyone is cisgender and neurotypical) can add to distress.

Limitations

• Self-selected online sample. People chose to take part, so the group may not reflect all neurodivergent trans and gender diverse people with eating disorders. Those without internet access, or who find written surveys hard, may be missing.
• Who took part. Most participants were assigned female at birth and fairly young, and all lived in the UK. Experiences of older people, those assigned male at birth, and people elsewhere may differ.
• Written answers. Two open questions give less depth than interviews, and researchers could not ask follow-up questions.
• No comparison group. The study cannot say whether these factors are unique to this group.
• Not about cause. This is qualitative research about how people understand their own experiences. It does not show that any factor causes eating disorders.
• Unclear from the abstract is how autism, ADHD and eating disorder experiences were identified. The author list includes a lived experience advisory group, but the abstract does not describe its role.
• Early version. The journal says this is an early, accepted version of the paper that may still be edited before the final version.

This piece summarises the paper’s abstract. The paper is open access, so you can read it for the full methods and findings.