I spent the summer of 2015 playing the part of an anorexic girl’s stomach in a show about eating disorders. Her stomach was shriveled and starving. So was mine, although I didn’t know it at the time. Back then I thought there was no way I would ever develop an eating disorder. I wasn’t female. I loved food too much. I didn’t fit the role of a skinny white teenage girl who succumbed to the images in magazines. As a person of trans experience, I now realise where my oblivion and deep-rooted denial came from: there is a significant lack of inclusive representation of identities in our discussions about eating disorders. An eating disorder is not about hating food or a sole desire to be thin. It is a mental illness with one of the highest mortality rates. 1 It is an attempt to control the uncontrollable. Illness does not discriminate, and people of all genders develop eating disorders for different reasons. I share my experiences of anorexia and gender dysphoria in the hope that people going through similar challenges realise that their experiences are real.
Like eating disorders, everyone experiences gender dysphoria differently. For me, dysphoria and anorexia work in shifts: when one sleeps, the other one keeps a watchful eye open. Some days it can feel like the only way to escape dysphoria is to fall into the eating disorder’s jaws. There was a point at which anorexia had suppressed my body’s feminine features so much that for the first time since childhood, I saw my body as a genderless vessel. I finally felt in control of a body that I previously had no ownership of. In reality, I had lost control of my actions at the cost of my physical health. The comfort of my shapeless body relieved my mind of dysphoria. I continued to run away from feeling anything for a long time, until I ended up in a hospital bed wondering why I was surrounded by a sea of frail bodies. Here, I was forced to lend my trust to people around me. They told me recovery would mean moving away from the edge between life and death, but I wanted to stay in the nest of my eating disorder. On the other hand, a small reasoned part of me knew that recovery would give me the freedom I had lost. It would also mean dealing with dysphoria again, and that was a daunting thought.
We talk about eating disorders in a gendered way. The media are quick to blame skinny models and feminine standards of beauty for the apparent eating disorder epidemic, and most recovery resources are designed to help cisgender women. This makes sense because most people affected by eating disorders do identify as female. However, it would be wrong to assume that eating disorders are exclusively a women’s issue, let alone to assume that people whose bodies were assigned ‘female’ at birth identify as women. A recent study in the US — one of the few studies on eating disorders that includes transgender people — found that 15.8% of the transgender population suffer from an eating disorder, compared with 1.8% of heterosexual cisgender women.2 Despite having a long way to go in tackling the stigma surrounding masculinity and mental illness, it is also promising to see that visibility is growing around cisgender males with eating disorders. The needs of cisgender females, and now increasingly more males, are largely being addressed by healthcare providers and support services, but for people whose identities transcend the gender binary, it can be hard to be taken seriously by those who we turn to for help.
Acknowledging our identity can be difficult when we do not see ourselves reflected in everyday life, which is the case for many marginalised groups. If the intersections of my gender identity and mental illness were represented in media or medical education, I believe I would have accepted my situation more readily. I know of many people in our community who regularly encounter health professionals who are unwilling to listen to or learn from our stories. If our conversations around eating disorders challenged the stigma around transgender identities, health professionals may also feel more confident in talking about these issues with their clients. Most medical experts resist because they are afraid to talk about trans people with eating disorders. I recently spoke to a youth worker at a hui in Whanganui who was working with a young transgender person struggling with anorexia. Despite needing urgent support, he was denied help from the local eating disorder service because health professionals did not understand his gender identity. Gender-diverse people need to be able to enter health and support services knowing that we will not be discriminated against, or have our experiences undermined.
Despite the anticipated return of some dysphoria that I cannot control, wonderful things have happened since starting recovery that my brain wouldn’t allow me to believe when I was at my lowest point. My relationships with other people have grown stronger. I have gained autonomy over my body and can now imagine a future beyond the anxieties of my next meal. I am in awe of the miracles my body performs every day without me even being aware that they are happening. I accept that male-identified people, including myself, come in all shapes and sizes and that is something to embrace. My body is a transgender body which informs my morals, academic interests and sense of self. Dysphoria still washes over my brain some days, but I now experience it with the wisdom that it will pass. After all, permanence is an illusion. Our minds and bodies are ever-changing landscapes that deserve to heal.
I wonder what would have been different if I had known that, acting as a grumpy stomach in the summer of 2015, I was worthy of help. If transgender people with eating disorders were openly represented in society, maybe I would not have denied my situation for so long, or others around me would have had the knowledge to make the connection between my dysphoria and mental illness. As individuals sharing our experiences and as health professionals working alongside gender-diverse people, we are collectively responsible for creating safe and inclusive environments for those who are relentlessly pushed to the boundaries. We can choose to embrace the unpredictable parts of recovery that might otherwise be feared. Instead of making gendered assumptions about mental illness, let’s become curious of difference.
 Arcelus, J. (2011). Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders. Archives Of General Psychiatry, 68(7), 724. http://dx.doi.org/10.1001/archgenpsychiatry.2011.74
 Diemer, E., Grant, J., Munn-Chernoff, M., Patterson, D., & Duncan, A. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal Of Adolescent Health, 57(2), 144-149. http://dx.doi.org/10.1016/j.jadohealth.2015.03.003
Alex Ulrich Ker has been exploring his own gender identity for the last five years, and views his transition as an ongoing adventure. He sees gender as a puzzle and is trying his best to solve it. He is particularly interested in the relationship between gender and the body, and how individuals can challenge the gender binary through ordinary interactions in everyday life.