Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York.
Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York.
J Adolesc Health. 2024 Jan;74(1):18-27. doi: 10.1016/j.jadohealth.2023.07.027. Epub 2023 Oct 4.
This systematic literature review explores the evidence base related to the diagnosis and clinical management of eating disorders among transgender and gender nonbinary (TGNB) youth. Through an exploration of the literature, this review highlights key considerations for providers working with this population, including the complex relationship between body image and gender, the assessment of subthreshold eating disorder symptoms, the impact of gender-affirming care on eating disorder treatment outcomes, and available evidence-based metrics, with attention to factors impacting treatment, including family support, psychiatric comorbidities, and community safety.
We conducted a search of the databases PubMed and Ovid MEDLINE for articles pertaining to eating disorders and TGNB youth, with forward citation chaining conducted via Google Scholar to provide a review of recent publications. Twenty-six articles published from 2017 to 2022 met the criteria for full-text review.
The selected articles primarily explored data from the United States and varied widely in methodology, including a systematic literature review (n = 1), narrative literature reviews (n = 3), case series (n = 4), case studies (n = 2), cross-sectional population surveys (n = 7), cross-sectional patient surveys (n = 3), other cross-sectional studies (n = 3), retrospective chart reviews (n = 2), and a retrospective longitudinal cohort study (n = 1). Most commonly, researchers sampled patients within the setting of gender clinics. Researchers used a range of validated measures in clinical settings, with the Eating Disorder Examination Questionnaire most frequently reported. The literature highlights several considerations unique to transgender populations, including the complex relationship between gender dysphoria, body dissatisfaction, disordered eating behavior, and gender-affirming care.
In clinical settings with TGNB youth, providers may consider implementing validated screening measures to assess for eating disorders. Future research should emphasize a nuanced understanding of the heterogeneity among TGNB patient populations and the impact of gender identity on treatment of eating disorders.
本系统文献综述探讨了与跨性别和性别非二元（TGNB）青年的饮食障碍诊断和临床管理相关的证据基础。通过对文献的探索，本综述强调了为该人群提供服务的临床医生需要考虑的关键问题，包括身体意象和性别之间的复杂关系、阈下饮食障碍症状的评估、性别肯定护理对饮食障碍治疗结果的影响，以及现有的基于证据的指标，同时关注影响治疗的因素，包括家庭支持、精神共病和社区安全。
我们在 PubMed 和 Ovid MEDLINE 数据库中搜索了与饮食障碍和 TGNB 青年相关的文章，并通过 Google Scholar 进行了前瞻性引文链接，以提供对近期出版物的综述。从 2017 年到 2022 年发表的 26 篇文章符合全文审查标准。
所选文章主要探索了来自美国的数据，方法差异很大，包括系统文献综述（n=1）、叙述性文献综述（n=3）、病例系列（n=4）、病例研究（n=2）、横断面人群调查（n=7）、横断面患者调查（n=3）、其他横断面研究（n=3）、回顾性图表审查（n=2）和回顾性纵向队列研究（n=1）。研究人员最常在性别诊所的环境中对患者进行抽样。研究人员在临床环境中使用了一系列经过验证的测量方法，其中最常报告的是饮食障碍检查问卷。文献强调了跨性别群体特有的几个考虑因素，包括性别焦虑、身体不满、饮食障碍行为和性别肯定护理之间的复杂关系。
在 TGNB 青年的临床环境中，提供者可以考虑实施经过验证的筛查措施来评估饮食障碍。未来的研究应强调对 TGNB 患者群体的异质性和性别认同对饮食障碍治疗的影响有更细致的理解。
