What does it mean to live authentically? 

Honoring your truth.

In other words, understanding, accepting, and nurturing your various, intersecting identities, to live your best life. This was a major theme throughout a special event held in February at Towson University (TU) to help recognize National Eating Disorders Awareness Week.At the event, speaker Ryan Sallans shared his personal experience of gender identity development and eating disorder recovery with the TU community. Organized by TU’s Counseling Center, the event was well-attended and brought together various university and local organizations, including The Center for Eating Disorders at Sheppard Pratt, TU’s Center for Student Diversity and The TU Body Image Peer Educators (BIPE). Sallans is a well-known public speaker, author, and health educator, and has been featured on Larry King Live, NPR, The Advocate, and many other news and popular media outlets.

Documenting Self-Discovery through Transition and Recovery

Throughout his talk, Sallans highlighted the delicate balance between taking care of oneself and navigating important relationships that often change throughout transition. Of course, each individual’s experience is different and Sallans did well to emphasize his is only one story among many.

Despite transgender and gender non-binary identities being discussed more openly than ever, there remains a stark deficit in information regarding the intersection of body image, gender identity development, and eating disorders. Studies have suggested the prevalence of eating disorders is higher among transgender individuals when compared to the general population (Reisner et al., 2016; Watson, Veale, & Saewyc, 2016). This health
disparity is likely influenced by the pervasive effects of transphobia in our society, which sets the stage for inequality and discrimination at home and beyond, creating unique risk factors for the trans community (Bockting, Miner, Swinburne-Romine, Hamilton, & Coleman, 2013; Watson et al., 2016).

Pair this with the fact that no one is immune to the influence of the multi-billion dollar beauty industry consistently sending a message that, in order to be happy, we must look a certain way. Each one of us, regardless of gender, is sold (to some extent) on the idea that by controlling our bodies, we can achieve happiness, wealth, and popularity. Those working in the eating disorder field have historically referred to this as the internalization of the “thin ideal” or the acceptance of unrealistic or narrow beauty standards (Thompson & Stice, 2001). Transgender individuals are not immune from this culturally normative body dissatisfaction.  But people with eating disorders who identify outside of the restrictive gender binary may also experience amplified body dissatisfaction because their gender identity and their sex assigned at birth do not match (Algars, Alanko, Santtila, & Sandnabba, 2012; Strandjord, Ng, & Rome, 2015).

Furthermore, adjusting to a changing body and gender expression (for those who opt for cosmetic, hormonal, and other gender-affirming interventions), as well as the public commentary this process often evokes, presents its own unique challenges that impact body image and self-esteem (Couturier, Pindiprolu, Findlay, & Johnson, 2014).

How does one survive, and thrive, when faced with such challenges?

Sallans encouraged everyone in the room that night to stay hopeful and connected, which for him means sharing life stories to better understand those that are different. His comments suggested tremendous patience and empathy for his loved ones’ process of arriving at a place of acceptance with his transition, while also emphasizing the need to disconnect at times to protect oneself. Sallans identified a number of strategies and resources he has found useful, starting with a non-judgmental awareness of his needs, his boundaries, and his triggers. He explored the role of psychotherapy, as well as self-guided research on lesbian, gay, bisexual, and transgender issues, in helping him to turn towards his inner truth and wisdom.

Consistent with national guidelines on psychotherapy with LGBTQ individuals, Sallans benefited tremendously from collaborating with an affirmative therapist; someone he was able to confide in during times of confusion and fear surrounding gender identity, at a time when very few were even considering gender outside of the binary. The trust and respect he built with his therapist created a safe space to discuss gender issues and eating disorders, which provided the platform for recovery and ultimately allowed for closer and more authentic connections with family and friends. Outside of therapy, Sallans said he found it incredibly useful to communicate about his emotions and take time out for himself. He acknowledged the need to unplug from negative relationships (and social media) and engage in routine self-care, which for him often includes going for walks and being in nature.

Self-care, use of coping skills for managing negative emotions, positive sense of identity and community, and feeling like you can count on those closest to you are universal factors associated with resiliency (Rutter, 2012). These factors are even more relevant for those who identify outside of the gender binary (Hill & Gunderson, 2015; Watson et al., 2016). If you or a loved one is struggling with an eating disorder and questioning gender identity, see the resource links below to gather information, find community, and get professional support.

For information regarding affirming and evidence-based treatment options and programs at The Center for Eating Disorders at Sheppard Pratt, please contact us at (410) 938-5252 or email us at [email protected].

Additional Resources:
https://www.ryansallans.com (Ryan Sallan’s Official Website)
www.genderspectrum.org
www.glaad.org
www.pflag.org
www.thetrevorproject.org
https://www.chasebrexton.org/our-services/lgbt-health-resource-center

Written By: Andrea Castelhano, PsyD, Outpatient Therapist – Dr. Castelhano is a licensed clinical psychologist in the outpatient department at The Center for Eating Disorders at Sheppard Pratt. She earned her doctorate in Clinical Psychology at the American School for Professional Psychology at Argosy University, DC where she received training in cognitive behavioral therapy and mindfulness-based approaches to psychotherapy. She also received specialized training in eating disorders, anxiety disorders, and co-occurring self-harm and suicidality. Additionally, she has provided affirmative therapy to individuals in the LGBTQ+ community throughout her training and professional career. Affirmative therapy is a therapeutic approach that respects individuals of all sexual orientations and genders, recognizes the impact of intersectionality on identity development and life experience, and addresses issues including discrimination and heterosexism as they relate to the individual’s broader treatment goals. Dr. Castelhano joined The Center for Eating Disorders in 2018 and brings her experience from a variety of clinical rotations, including a year-long practicum at Children’s National Medical Center Outpatient Eating Disorders Clinic,  APA-accredited clinical internship at Laureate Psychiatric Clinic and Hospital, and post-doctoral fellowship with the University of Tulsa Counseling and Psychological Services Center. She provides individual, family, and couples therapy, as well as psychological testing services. She is fluent in Spanish and Portuguese.

References

Algars, M., Alanko, K., Santtila, P., & Sandnabba, N.K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders: The Journal of Treatment & Prevention, 20, 300-311.

Bockting, W.O., Miner, M.H., Swinburne-Romine, R.E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943-951.

Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N. (2014). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating Disorders, 48, 151-155.

Hill, C. A., & Gunderson, C. J. (2015). Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychology of Sexual Orientation and Gender Diversity, 2, 232-252.

Reisner, S.L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, … Baral, S.D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388, 412-436.

Rutter, M. (2012). Annual research review: Resilience – clinical implications. The Journal of Child Psychology and Psychiatry, 54, 474-487.

Strandjord, S.E., Ng, H., Rome, E.S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. International Journal of Eating Disorders, 48, 942-945.

Thompson, J.K. & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181-183.

Watson, R.J., Veale, J.F., & Saewyc, E.M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50, 515-522.