A child who is gender fluid, transgender, non-binary, or otherwise gender creative may need special treatment for their eating disorder. The fact is that the intersection of eating disorders and gender identity can be a bit tricky, and it’s best to get specialized, trained care. This can be challenging, so I’ll walk through some of the things to think about.
Our child, who is non-binary, has been attending a day treatment program for an eating disorder for the past three weeks. They say they’re fine, they’re cured, and the treatment is not helpful. According to them, eating disorder treatment is full of microaggressions and that their treatment team knows nothing about gender dysphoria or how to talk about their gender. They also say they don’t like the other people in the program. They say that those people are actually teaching them new things about eating disorders and making them feel worse.
In short, they hate treatment and they say that they’re fine now and shouldn’t have to go. They are very insistent and demanding about this. They say going to treatment is causing more harm than their eating disorder did.
While their weight is stable and their behaviors seem OK right now. I’m really afraid to do this. Should we pull them from the treatment center? Is it possible the eating disorder is gone? If I do pull them, what, if anything, do we do instead?
Well, Brian, I can understand why you’re concerned. This is a really challenging situation. First, I think it’s important for me to say that I am cisgender. I’ve done a lot of research into this topic, but I don’t have personal experience as a trans or non-binary person.
But I have worked with parents in your situation, and am aware of the connection between having an eating disorder and being non-binary.
What I’ve learned is that is we need to start by paying attention to the similarities and differences between gender dysphoria and body dysmorphia.
So we know that body dysmorphia is a common symptom of an eating disorder. And it’s basically an inaccurate picture of what your body looks like and distorted beliefs about what is a good body or what their body should look like. Typically, what we’re experiencing here is a person who believes their body is too large or larger than they think it should be or they want it to be.
So that’s body dysmorphia. And like I said, we see it with eating disorders and we generally treat it by helping people understand and accept their own bodies. Body dysmorphia is treated by helping the person accurately see their body as it is and respect the body as it is.
So treating body dysmorphia is about accepting the body as it is, and that’s pretty different from how we treat somebody who has gender dysphoria.
Whether or not they have gender dysphoria, the treatment for someone who is non-binary is to affirm their gender. So this is a very different process from saying you need to accept the body you have, which is the treatment for body dysmorphia.
With gender dysphoria or anything having to do with gender identity, we affirm that person and we support them in taking steps to affirm their gender. That may look like changing their clothing style, changing their pronouns, changing their name. It may or may not include hormone treatment and/or surgery.
The point is, when we have a non-binary child, what we’re trying to do is affirm the gender they identify with rather than accepting the gender they were assigned at birth.
Treating body dysmorphia and gender dysphoria
So these very two different approaches combine and can sometimes conflict in eating disorder treatment.
You have a child who needs to learn to accept their body weight while at the same time we need to affirm their gender. And the truth is, we know in the eating disorder community that not many professionals have experience with this.
Most eating disorder treatment professionals are cisgender and have not received training in gender identity and gender dysphoria. What that means is we sometimes have very well-meaning professionals who are experts in eating disorder treatment, but they may not have the tools, the awareness or the training to fully support a non-binary person.
Ask the treatment center
So the first thing I would be doing if I were in your position is to contact the treatment center and ask them specifically how they handle gender identity. What training do they have? How they are supporting nonbinary, trans and non-binary people who come into the treatment program?
And frankly, if their answer is kind of wishy-washy, if they aren’t doing any specific training or intensive work on this topic, I might look for other treatment options.
That’s not because these people aren’t experts on eating disorders and not because they don’t mean well. I’m sure they do. But the fact is they may just not have the capacity to really learn about the gender issues that are most likely impacting your child’s eating disorder.
So I would start by asking them and if their answer isn’t satisfactory to you, I think that’s something to pay attention to.
The people in treatment
Now let’s take a quick minute to take into account what your child said about the people they’re meeting in treatment.
We do know that treatment centers have people in them with other eating disorders. So it’s definitely worth listening to that complaint and considering whether you should take it seriously.
And again, this could be something that you talk to the treatment center about.
Also, consider if your child is the only non-cisgender person in the program, since that might be uncomfortable as well. These are all valid issues with treatment that are known. These are not surprises and they’re not very unusual for kids who are non-binary. And they do need to be addressed.
But the answer is not to end treatment completely. What I’m hearing here is possibly a mismatch in treatment, not full recovery. Full recovery from an eating disorder takes time. And that’s because we always have to remember that an eating disorder is a mental illness. It’s driven by psychological factors.
So we can treat the behavior and we can treat the physical complications of having an eating disorder. But that doesn’t necessarily mean that the person is recovered from their eating disorder.
They can have lingering effects that are based on the psychological nature of these disorders. So what I would suggest to you is to look into whether you can do one-on-one treatment.
I know that insurance doesn’t always support one-on-one therapy and treatment for an eating disorder, but it might be the most ideal situation for your child.
What you’re looking for are three professionals:
A psychotherapist will work on the psychological aspects of the eating disorder.
2. Registered Dietitian
A registered dietitian will monitor their eating and nutritional behavior.
A physician will monitor their vital signs and weight, just to make sure that they’re staying in a physiologically healthy range.
It does get a little challenging because you’re looking for three people who have experience working with eating disorders, specifically.
Eating disorders are a specialized category. Not everyone can or should treat them.
And additionally, you’re really looking for someone who has experience working with gender identity. In a perfect world, you would be able to find treatment providers who are non-binary, or at least not cisgender. But that can be really challenging.
What I would insist upon is that anyone you work with should be curious about and pursuing training and supervision regarding gender identity.
What’s most important
What’s most important here is that your child deserves to feel affirmed and seen by their providers.
Brian, thank you so much for a great question and for looking out for your child. Your non-binary child deserves compassionate and informed care for their eating disorder. I hope this has been helpful as you think about the best path forward.
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