Content warning: mention of depression, self-harm, depression; discussion of eating disorders and gender dysphoria.
Contrary to popular narratives about eating disorders, I did not grow up hating my body or thinking I was fat. I struggled instead with a number of other things: I grew up fearing puberty and the feminizing changes everyone told me would happen. I only later learned this was a result of my gender dysphoria. I grew up with a lot of food rules. And I grew up in elite athletics. All of these factors brought attention to my body and my ability to control it – a perfect storm for the development of an eating disorder. So here is more about my experience.
The summer before my junior year in high school, the summer of 2012, I broke my back in a biking accident that left me in a body brace for several months. This took away my number one vice, passion and pastime: swimming. Before my injury, I’d been training for 20+ hours a week and competing multiple times a month. In the emptiness that ensued without swim practice (which not only had been an outlet and something I loved, was also the main source of my social life), my mental health deteriorated. I began struggling with depression, self-harm, and most centrally: my eating disorder.
While my back healed relatively quickly, my mental health did not. I spent the next few years in and out of crisis, hospital visits, and therapy. I want to be clear: I am very grateful that my parents were supportive of therapy both ideologically and financially. Still, the psychological resources we had were less than ideal. No one seemed equipped to deal with me properly and I felt like no one truly understood me – most of all myself. At this time, I was still competing and training to be recruited to swim in college, I was competing at national-level meets, I was maintaining my perfect grades… And my mental health continued to spiral as a result of not prioritizing it.
Towards the end of my senior year in high school, I switched to a new therapist who told me frankly, “I can’t help you. You need residential treatment. Rehab. You can’t go to Harvard in the fall, you need to take a gap year.” She went on to remind me that not taking care of myself would only result in further misery. In continued misery. So, despite the panic that I felt in hearing this – I was supposed to put my whole life on hold for a year for mental health?? I had never been taught to prioritize this, what was I going to tell my coaches?? – I knew she was right.
The day after my high school graduation in June of 2014, I checked into a treatment center in Miami, FL, called the Oliver Pyatt Centers (a Monte Nido Affiliate). I spent 131 days there, which was about 5 months. It was there that I finally slowed down and actually took a pause. As part of the treatment program, I wasn’t allowed to swim or exercise, I was removed from my family and friends, I wasn’t in school… And in that space, I was also finally able to realize I am transgender.
My treatment at OPC, most specifically, my therapist there, saved my life. My therapist forced to me think about myself and my gender and my happiness in a way that drove to dissect who I was and how I understood success. Especially in the context of what made me happy. (This involved my gender, of course, but also had many other repercussions as my gender was not the only thing I was working through at the time.) It’s been almost 6 years since I entered treatment and I have not engaged in eating disorder behaviors since.
I am very proud of my hard work and recovery but I always think it imperative to recognize thatI arrived here as a result of privilege, too. Privilege of access to treatment, privilege and luck of good therapists, privilege of parental support…
Unfortunately, not everyone has access to treatment, much less inclusive and gender-affirming treatment. So while I am so grateful for my experience and never want to dismiss the privilege that I hold, I am also fighting for the day when none of these are privileges, but rather expectations. For this reason, I am Monte Nido’s National Fellow, and work with them to advance gender-inclusive and gender-affirming care to improve access and treatment experience for all folks with eating disorders.
An Important Terminology Note:
Gender dysphoria: what many trans people struggle with; a struggle rooted in the incongruence between gender identity and assigned gender.
Body dysmorphia: characterized by an obsessive (negative) fixation of specific body parts, usually aligned with Body Dysmorphic Disorder (BDD).
So in conclusion: Gender dysphoria is NOT the same as body dysmorphia. Gender dysphoria is rooted in an incongruence of identity, body dysmorphia is not. Body dysmorphia is not rooted in incongruence of identity but rather issues of self-worth and trauma. In some extreme cases of body dysmorphia, patients have urges to cut off parts of their body, such as their arms or fingers or legs. This is then weaponized against trans people – claiming that we are just experiencing cognitive distortions and that’s why we want to remove / change certain body parts. But this is not the case. Being trans is not a mental illness or a cognitive distortion.
LGBTQ+ youth are affected by eating disorders more than any other demographic.
A few posts on this: