National Eating Disorders Association
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Dear Chase: My Parents Believe That Being Trans and Having an Eating Disorder are Choices. Help!

Chase Bannister is the founder, senior vice president and chief strategy & clinical integrity officer for Veritas Collaborative, a specialty hospital system for the treatment of eating disorders in a gender-diverse and inclusive environment. He is credentialed as a certified eating disorder specialist by the International Association of Eating Disorders Professionals and is a licensed clinical social worker. Chase combines clinical and executive expertise to nurture a spirit of meaningful collaboration and carries a zeal for advancing public awareness on eating disorders.

My parents think that being trans and having an eating disorder are both choices I’ve made in my life. How do I start a conversation with them to break that stigma?

It can be really challenging when the people that you love struggle to understand who you are and what you are experiencing. This can contribute to feelings of isolation and depression. Please know that there are people who understand and are willing to help you and your family through this very difficult time.

There are many misconceptions about what causes eating disorders and what contributes to one’s gender identity. The most harmful of these misconceptions is that eating disorders and gender identity are choices. Inferring choice leads to blame and shame, discourages communication and help-seeking, and can lead to the deterioration of mental and physical health. To date, there is strong evidence to show that eating disorders and gender identity have environmental, biologic and genetic factors that contribute to their development.

Brain structure and function - Research shows there are significant differences in the brain structure and function of individuals with eating disorders. Brain-imaging studies have shown that areas of the brain are smaller (grey matter), the integrity of the white matter that connects these brain areas can be compromised, and messages related to hunger, satiety, anxiety, reward and motivation are not received in the same way as they are in the brains of those without eating disorders. Additionally, animal and human studies have shown that neurotransmitters involved in mood, reward, and appetite regulation are different in subjects that experienced eating disorder related behaviors and symptoms compared to those that have not. In short, signals from the body are being misinterpreted by the brain.

Genes - Although scientists have not yet identified a specific gene that predicts eating disorders, they have identified a number of misspellings in the human DNA sequence, called single nucleotide polymorphisms (or SNPs) that may relate to eating disorder symptoms. Researchers around the world are working together to determine which SNPs are most strongly associated with eating disorders.

Environment and experience - Research has also shown that life experience, stress, trauma and eating behavior can change the way genes are expressed and alter neurotransmitter function. Taken together, the evidence supports the fact that eating disorders are not a choice, but a perfect storm of biologic, genetic and environmental influences that result in these devastating disorders. 

Similarly, research on gender identity has shown that brain structures and function are different in transgender persons compared to cisgender persons (individuals whose biologic sex matches their gender identity). There is evidence for a genetic basis to gender identity, and data suggests there may be differences in neurotransmitter function in transgender individuals.

Helping your parents to understand that there is a strong biologic and genetic component to eating disorders and gender identity may help them to realize that you are not choosing to have an eating disorder or choosing to be trans. Seeking help from mental health professionals and incorporating your family members into your treatment can be powerful tools in fighting the stigma you are experiencing. It takes an incredible amount of insight to recognize stigma and even more strength and courage to challenge it. You are an amazing force for change!