For the past many years, I have struggled with an eating disorder. Searching for a therapist, I have called several locations. Each time, they assumed that because of my voice I was a man and would want to be a part of their men’s services. When I corrected and explained that I’m not a man, they assumed I was a woman and would want treatment with other women.

My options always remained limited to my gender. As my gender is neither male nor female, I felt myself lost as to how I could find care and help myself in ways that did not simultaneously erase my gender, especially as my experience as a gendered person affects my experience with an eating disorder.

I am not alone in this struggle. There’s a disproportionate rate at which trans people experience eating disorders and face a multitude of barriers to seeking treatment. Here are four ways to begin thinking of eating disorders in relation to trans people, primarily non-binary trans people, and to work towards degendering these services and institutions.

1. Rethink and expand discussions of gender and eating disorders beyond the binary

On the National Eating Disorder Association (NEDA) webpage, they highlight that eating disorders are gender neutral (which they use to mean that eating disorders can affect any (a)gender). NEDA, and many others, though, highlight the ways in which men and women require different treatments because of their gendered experiences. Why then are the gendered realities of trans people not taken into account when developing programs to help individuals heal and recover?

Trans men are men and trans women are women, but their experiences probably will not be that of a cisgender man or woman. Additionally, gendered violence is often enacted based on how a person is perceived, not how they identify. So, for instance, I have experienced gendered violence based on people seeing me as a woman, a trans femme, a non-binary person, a cis gay man, and a femme man, and each of these separate layers and experiences has affected the development of my eating disorder.

Growing up in rural Utah, I assumed that since I wasn’t a boy, I must be a woman, as I didn’t have access to the multitude of webpages and resources that now exist about non-binary genders. When navigating femininity attached to cis women, I learned I had to be thin, small-framed, and dainty in order to truly be that which I saw myself as. To be the tall kid with broad shoulders who was medically diagnosed with obesity (which is inherently problematic in and of itself) meant I would never match up to the expected femininity among my cis female friends.

More Radical Reads: More Complicated Than You Think: Eating Disorders and Trans Identities

Simultaneously, as a then gay boy, my straight friends indirectly taught me what it meant to be a successful gay boy, which was basically to be a twink or to be muscular. I consistently was asked, “Why are gay boys so attractive?” with the question never referencing me, but rather the thin, hairless, masculine guys spread throughout gay media like termites.

Non-binary identities challenge the idea of what it means to be masculine and/or feminine by embodying bits of both or neither. In doing so, nonbinary folks often experience gendered violence from multiple directions depending on how they’re perceived and read on a given day. And as eating disorders are a symptom of gendered violence, non-binary people experiencing multiple forms of gendered violence require different conversations, recovery processes, and understandings than the gender binary allows.

2. Discuss and unpack the oppressive politics of desirability

As I found home in my non-binary femme identity and quickly lost access to jobs, housing, public accommodations, I felt a failure in every way possible: failure at being a gay boy, at being femme, and at being a human in general. Dates and hookups became scarce unless I was being fetishized or fetishizing myself. I needed something to hold on to, to give me the ability to say “I am desirable and worthy and loveable,” setting the stage for my then-disordered eating to morph into an eating disorder.

Trans people are rarely seen as desirable, even amongst themselves. A trans person often only becomes desirable to cis people when they “pass” as a cis person themself. For some binary and non-binary people, there is no desire to pass beyond the necessary needed at times to survive. Additionally, many trans folks simply cannot “pass” due to systemic barriers that prevent them from accessing surgeries that would allow them to look as they desire.

This inability — or lack of desire — to pass as cis challenges cisnormative ideas of what it means to beautiful. But challenging what beauty means has never been an easy task. I can’t count the number of times I’ve been called a “monster,” an “it,” ugly, and so on. I can, however, count the number of times I have been seen as desirable. More often than not, those times were when my body weight was lower, as my femme was given more validity in those moments.

I think it’s easy to say that people like that aren’t worth our time or that we deserve better or that we find ourselves desirable and that’s enough. But reality doesn’t match that. It’s hard to feel undesirable. And often times, that feeling of being undesirable becomes the way in which we perceive ourselves. Being trans doesn’t mean that I inherently dislike my body, but it does mean that others have worked to make me hate it.

3. Differentiate between gender dysphoria and body dysmorphia

The monolithic trans narrative that we are told is that trans people are born in the wrong bodies and they hate the bodies they’ve been trapped in. This narrative often erases the countless experiences of binary and non-binary trans folks who never felt like they were born in the wrong body. Because this narrative is too often told, people, including doctors, come to believe it as truth for all trans people.

I went to the doctor once hoping that she could help me manage my anxiety. In the visit she found out I was trans and that I also had an eating disorder. She assumed I hated my body because I was trans and not because of the eating disorder, subsequently mentioning that I should begin seeing a therapist so I could navigate and figure out my identity and its relation to my body. She tried to explain to me all the possibilities of surgeries and hormones and ways in which I could alter my body in order to love it. At the time, I worked at an LGBT resource center and had already been doing community organizing work that gave me knowledge of all the things she assumed I couldn’t possibly know. But more importantly, she glossed over my explanation of hating my body and the fat on it that I saw/see as undesirable, and instead moved on to my “lack” of breasts and a vagina as the explanation.

She was half right in that my transness did relate to my eating disorder, and I needed a therapist who was trans-friendly and aware. However, I have never hated the ways in which my body developed through puberty. Instead, I have learned to hate the ways in which it stores food. I have learned to see my not exercising in a given day as the doorway to gaining five pounds in the next. I have learned to see my body not as something beautiful to nourish and take care of, but something to control and manage so as to ensure that it doesn’t get too “unwieldy”.

More Radical Reads: I Was My Own Body Terrorist and My Transition Saved My Life

Gender dysphoria means that an individual either does not see their body as they want it to be or that society does not see it as they perceive it themself — all of this in relation solely to their gender. Body dysmorphic disorder means that an individual perceives their body as the wrong shape, size, you name it. Sometimes these interact. However, a trans person does not have to be experiencing gender dysphoria in order to have body dysphoria. A trans person does not always hate their genitals in addition to hating their body for not being thin enough or muscular enough.

Access to therapy needs to reflect this. It is not enough to have some therapists who help with recovering from an eating disorder and other therapists who help trans folks navigate transphobia and gender dysphoria. We need to have therapists who are able to acknowledge and validate the multitude of (a)gendered experiences an individual may have had that led to an eating disorder without assuming false causes.

None of this is to say that eating disorder professionals need to ignore gender dysphoria. On the contrary, they need to remember it as they seek to help folks who are currently struggling. For people with gender dysphoria who cannot gain access to gender confirmation surgery, learning to love their body as it is can be nearly impossible. The goal of eating disorder treatment needs to push beyond telling people there is nothing wrong with their bodies or that they merely need to love it as it is. Instead, the question that should be asked is, “How do we get to a place of loving ourselves while allowing room for us to want some things to change in ways that are safe for our bodies?”

4. End the binary of perpetrator and victim

In most social justice conversations, there is an assumed perpetrator and victim of oppression. Cis people are the perpetrators of cissexism and trans people the victims. People with eating disorders are the victims to people who perpetuate transphobia, misogyny, racism, you name it. Women are the victims and men the perpetrators.

We desperately need to shift this conversation toward a recognition that we are all perpetrators of violence. As a trans person, I have inflicted transphobia interpersonally with other trans folks. As a person with an eating disorder, I also recognize the multitude of ways in which I have continued to enact fatphobia.

What does it mean when I mentioned above that my eating disorder developed out of a need to feel desirable as a trans person and the only way I could do that was to become thin? It means that I have both internalized and perpetuated fatphobia. When we see ourselves desirable only when we are thin, we also begin to see others as desirable only when they are thin. It is not possible to map disgust onto my body because of the fat on it without beginning to map disgust onto all non-thin bodies.

Having an eating disorder is not an individual’s fault. Because of that, it’s easy to say that it’s not my fault or anyone else’s fault when we (people with eating disorders) see fat as an issue and something to hate. But life is so much messier, and our personal thoughts often express themselves in our interpersonal relations.

It’s important that we create processes of recovery from eating disorders that not only allow us to navigate a safer relationship with our bodies, but which also challenge us to question what accountability looks like for our own interpersonal and systemic enactments of fatphobia. To be honest, I’m not sure what that accountability is. At this point, it means recognizing my perpetuation of fatphobia and remembering who paid the cost of my enactment of it.

What I am asking for is not for us to begin catering to a small population that needs to have these conversations. Rather, it is well past time that society begins to recognize how the ways in which we’ve viewed gender and eating disorders have thus far been unable to hold all of the messiness that is humanity. I hope we can move the conversation forward together.

**If you are currently looking for resources that reflect trans folks, including non-binary people, check out Trans Folx Fighting Eating Disorders.

Alithia is a mentally ill, queer blobfish femme from rural Utah currently residing in Atlanta. Pronouns: they/them/theirs.

(Feature Image: Photo of a person with long brown hair and bangs sitting at a cafe looking down at a menu. They are wearing a long-sleeved orange, green, and white striped sweater. In the center of the table are red flowers. Velvet red curtains adorning a window can be seen blurred in the background. Source: Pexels)

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