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Gender dysphoria and eating disorders in adolescence: two case report

Ristori, J1Fisher, AD1; Castellini, G1; Ricca, V1; Maggi, M1

1: Careggi University Hospital, Italy

The co-occurence of Gender Dysphoria (GD) and Anorexia Nervosa (AN) has been described in the scientific literature. While the emphasis so far has focused on the overlap in symptomatology of the two conditions, this paper questions with longitudinal observations the actual idea of the occurrence of a “real” AN in adolescents with GD. Two cases of adolescents with GD and pathological eating behaviors are presented. Both received psychological evaluations at different times: at first admission to the GD clinic (T0) and 6 months after starting treatment with gonadotropin-releasing analogs (GnRHa; T1). In both cases, treatment with GnRHa not only improved psychological functioning, but also resolved pathological eating behaviors. In fact, both adolescents reported quick restoring of healthy food habits with restricting eating behaviors as well as intensive exercise no longer needed after treatment with GnRHa. Therefore, pathological eating behaviors (e.g. food avoidance and weigh loss) could be assessed as a dysfunctional copying strategy adopted to gain control over a body developing in an unwanted direction and to block irreversible physical pubertal changes. This psychopathological conceptualization of pathological eating behaviors in adolescents with GD stresses the importance of providing, in selected cases, early medical intervention such as pubertal suppression with GnRHa. Mental health professionals should therefore perform a specific and detailed assessment on sexual identity and gender identity within the evaluation of apparent eating disorders in adolescents. AN symptoms may in fact underline a GD diagnosis.


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