A systematic review of eating disorder experiences within transgender, non-binary and gender diverse populations, and an empirical study of childhood trauma, emotions, and the eating disorder voice

Matthews, Kirsty 2024. A systematic review of eating disorder experiences within transgender, non-binary and gender diverse populations, and an empirical study of childhood trauma, emotions, and the eating disorder voice. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

The current thesis focuses on eating disorders (ED) and is inclusive of two projects: a systematic review and an empirical project. For paper one, qualitative literature exploring the aetiology of EDs and disordered eating difficulties in gender diverse populations, as reported by gender diverse individuals, was reviewed. There is evidence to suggest that gender diverse populations may be at particular risk of experiencing mental health problems, and specifically difficulties with disordered eating, in comparison to cisgender peers. Evidence also indicates that disordered eating within this population may require different conceptualisation and treatment approaches. Qualitative research exploring healthcare and treatment experiences of gender diverse populations report considerable negative experiences of eating disorder treatment, with treatment largely geared toward cisgender individuals. To improve support for gender diverse service users, improved understanding of aetiology, presentation, risk, and protective factors of EDs within gender diverse populations is needed. Several databases were searched for relevant qualitative literature. In total, 14 papers were identified, reporting experiences of over 300 gender diverse individuals of a variety of binary and non-binary gender identities. Thematic synthesis was utilised to identify 6 overarching themes across papers: interconnectedness of gender dysphoria and eating disorders; gender expression; coping psychologically; surviving in the context of marginalisation; healthcare; and recovery and protective factors. Participants described the impact of gendered societal expectations, marginalisation, and stigma on their relationships with themselves and their bodies. Disordered eating, for many, provided a way of adapting their bodies to better align with their gender identity, and adapting themselves to better conform to societal expectations of gender; aiding passing as their gender identity in public and protecting them from discrimination and harm. Disordered eating also provided a way of coping with psychological distress caused by living in a body which differs from their gender identity, and the sense of a lack of control; over their bodies, lives, and circumstances (in particular, in relation to going through puberty and developing sex characteristics incongruent to their gender identity). Participants also described the positive impacts of gender-affirming care (including hormonal and surgical treatments) on disordered eating symptoms, as well as more negative influences, such as unwanted weight gain from hormone therapy. Barriers to accessing effective support for their EDs were identified. Protective factors associated with healing and recovery were also discussed. The findings of this review highlight the complex, intertwined nature of the relationship between gender identity and eating disorders and provides insight into the disordered eating experiences of gender diverse populations, as reported by this population. Clinical implications and future research directions are explored. The second paper is a quantitative study exploring the Eating Disorder Voice (EDV): an internal voice which focuses on weight, shape and eating and how they relate to self-worth. Specifically, this paper was interested in aetiology of the EDV, and the potential role it may play in explaining the relationship between childhood trauma and eating disorder pathology. Research into the EDV is still limited, but one study identified that the EDV is associated with childhood trauma, specifically emotional abuse; and identified potential mechanisms through which emotional abuse influences the EDV. Recent qualitative research expanded on this, suggesting the EDV develops during times of unsafety in a person’s life: offering comfort, safety, and guidance amidst distressing relational circumstances and associated internal and emotional distress. However, this safety is conditional, and the voice can become critical and cruel if rules are not followed. This qualitative research indicates that emotional difficulties may perhaps partially explain the relationship between childhood trauma and the EDV, with the EDV developing to provide support to manage the distress of traumatic experiences, particularly from childhood. Models exploring childhood trauma, emotions and eating disorder pathology more broadly have found similar mediational relationships, but this has yet to be explored in relation to the EDV specifically. The support the EDV provides may be of particular relevance within this model. This paper explores the potential roles of childhood trauma and emotional difficulties in the aetiology of the EDV. In total, 148 participants with self-reported experience of an EDV (recruited via social media and Cardiff University) completed a survey exploring childhood trauma, emotional difficulties, and appraisals of the EDV, as well as ED pathology. Analyses found that childhood emotional abuse (but no other experiences of childhood abuse) was significantly positively associated with appraisals of voice power. Higher problems with emotion regulation significantly predicted greater perceived power of the EDV. Mediation analysis found that emotion regulation difficulties was a significant mediator in the relationship between childhood emotional abuse and EDV power. Appraisals of EDV power was significantly positively correlated with severity of ED pathology. These findings provide some insight into the aetiology of the EDV, and the potential importance of the EDV and emotional difficulties when working with eating disorders. Limitations of the study, clinical implications and future research directions are discussed.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	9 September 2024
Last Modified:	09 Sep 2024 15:19
URI:	https://orca.cardiff.ac.uk/id/eprint/171938

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