Eating Disorder Clinical Presentation and Treatment Outcomes by Gender Identity Among Children, Adolescents, and Young Adults

Jessica H Baker; David Freestone; Kelly Cai; Scout Silverstein; Bek Urban; Dori Steinberg

doi:10.1016/j.jadohealth.2023.11.015

Eating Disorder Clinical Presentation and Treatment Outcomes by Gender Identity Among Children, Adolescents, and Young Adults

J Adolesc Health. 2024 Feb 4:S1054-139X(23)00596-7. doi: 10.1016/j.jadohealth.2023.11.015. Online ahead of print.

Authors

Jessica H Baker¹, David Freestone², Kelly Cai², Scout Silverstein², Bek Urban², Dori Steinberg³

Affiliations

¹ Equip Health, Inc., Carlsbad, California. Electronic address: jbaker@equip.health.
² Equip Health, Inc., Carlsbad, California.
³ Equip Health, Inc., Carlsbad, California; Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina.

PMID: 38310504
DOI: 10.1016/j.jadohealth.2023.11.015

Abstract

Purpose: Current eating disorder treatment approaches for youth were developed for use with cisgender girls, which limits the understanding of effectiveness for cisgender boys and transgender and gender expansive (TGE) youth. Here, we compare treatment outcomes for cisgender boys and TGE youth with cisgender girls receiving family-based treatment for an eating disorder.

Methods: Patients were aged 6-24 and either active in treatment or discharged from September 1, 2020, to November 1, 2022 (N = 1,235). Patient exposure to treatment varied given individualized length of treatment. Outcomes include eating disorder symptoms, depression, anxiety, suicidality, caregiver burden, and parental confidence in supervising treatment. Treatment outcomes for cisgender boys and TGE youth were compared with cisgender girls.

Results: Patients included n = 975 cisgender girls, n = 152 cisgender boys, and n = 108 TGE youth. Anorexia nervosa was the most common diagnosis. Cisgender boys reported significantly lower eating disorder (b = -2.7 [-4.1, -1.3]), anxiety (b = -1.6 [-2.2, -0.9]), and depression (b = -1.7 [-2.4, -0.9]) symptoms at admission compared with cisgender girls. TGE patients had significantly higher anxiety (b = 1.08 [0.28, 1.91]) and depression (b = 1.72 [0.78, 2.65]) symptoms compared with cisgender girls. Cisgender boys started with significantly lower suicidal ideation (b = -1.28 [-2.19, -0.43]) and TGE patients with significantly higher suicidal ideation (b = 1.63 [0.76, 2.51]) than cisgender girls. All symptoms improved during treatment and improved at similar rates over time in treatment regardless of gender identity.

Discussion: Early evidence from this study supports the use of family-based treatment for cisgender boys and TGE youth with eating disorders. Further research is needed on the long-term outcomes of this approach for youth of all genders.

Keywords: Adolescence; Anorexia nervosa; Eating disorder; Family; Gender; Telehealth; Treatment.