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Eating and Body Image Disturbances in Male-to-Female and Female-to-Male Transsexuals

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Abstract

The aim of the study was to discover whether persons with Gender Identity Disorder (GID) differed from controls of both sexes and from persons with eating disorders in terms of the degree of eating and body image disturbance, self-esteem, and depression. A total of 88 self-identified male-to-female transsexuals (MtF), 43 female-to-male transsexuals (FtM), 62 females with an eating disorder, 56 male controls, and 116 female controls completed the Eating Disorder Examination Questionnaire, Eating Disorder Inventory, Body Checking Questionnaire, Drive for Muscularity Scale, Rosenberg Self-Esteem Scale, and Beck Depression Inventory. MtF showed higher scores on restrained eating, eating concerns, weight concerns, shape concerns, drive for thinness, bulimia, body dissatisfaction, and body checking compared to male controls, and concerning some variables also compared to female controls. FtM displayed a higher degree of restrained eating, weight concerns, shape concerns, body dissatisfaction, and body checking compared to male controls. Furthermore, participants with GID showed higher depression scores than did controls, whereas no differences concerning drive for muscularity and self-esteem were found. Between MtF and FtM, the only significant difference emerged for body checking, with MtF displaying higher scores. Although it was shown that on these variables the values for persons with GID were lower than for those with eating disorders, these data lead us to speculate that persons with GID might be at a higher risk of eating disturbances. Therefore, the implementation of prevention programs might help persons with GID to avoid developing a clinically relevant eating disorder.

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Notes

  1. Data were not assessed for each of the five groups.

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

    Book  Google Scholar 

  • Beatrice, J. (1985). A psychological comparison of heterosexuals, transvestites, preoperative transsexuals and postoperative transsexuals. Journal of Nervous and Mental Disease, 173, 358–365.

    Article  PubMed  Google Scholar 

  • Beck, A. T., & Steer, R. A. (1987). Beck Depression Inventory-Manual. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Bodlund, O., & Armelius, K. (1994). Self-image and personality traits in gender identity disorders: An empirical study. Journal of Sex and Marital Therapy, 20, 303–317.

    PubMed  Google Scholar 

  • Byrne, S. M., & McLean, N. J. (2002). The cognitive-behavioral model of bulimia nervosa: A direct evaluation. International Journal of Eating Disorders, 31, 17–31.

    Article  PubMed  Google Scholar 

  • Cafri, G., & Thompson, J. K. (2004). Evaluating the convergence of muscle appearance attitude measures. Assessment, 11, 224–229.

    Article  PubMed  Google Scholar 

  • Cash, T. F., & Deagle, E. A. (1997). The nature and extent of body-image disturbances in norexia nervosa and bulimia nervosa: A meta-analysis. International Journal of Eating Disorders, 22, 107–125.

    Article  PubMed  Google Scholar 

  • Cash, T. F., & Hrabosky, J. I. (2004). Treatment of body image disturbances. In J. K. Thompson (Ed.), Handbook of eating disorders and obesity (pp. 515–541). Hoboken, NJ: Wiley.

    Google Scholar 

  • Cohen, L., de Ruiter, C., Ringelberg, H., & Cohen-Kettenis, P. T. (1997). Psychological functioning of adolescent transsexuals: Personality and psychopathology. Journal of Clinical Psychology, 53, 187–196.

    Article  PubMed  Google Scholar 

  • Cole, C. M., O’Boyle, M., Emory, L. E., & Meyer, W. J. (1997). Comorbidity of gender dysphoria and other major psychiatric disorders. Archives of Sexual Behavior, 26, 13–25.

    Article  PubMed  Google Scholar 

  • Coughlin, J. W., Edwards, R., Buenaver, L., Redgrave, G., Guarda, A. S., & Haythornthwaite, J. (2008). Pain, catastrophizing, and depressive symptomatology in eating disorders. Clinical Journal of Pain, 24, 406–414.

    Article  PubMed  Google Scholar 

  • Davison, T. E., & McCabe, M. P. (2006). Adolescent body image and psychosocial functioning. Journal of Social Psychology, 146, 15–30.

    Article  PubMed  Google Scholar 

  • Dobmeyer, A. C., & Stein, D. M. (2003). A prospective analysis of eating disorder risk factors: Drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness. Eating Behaviors, 4, 135–147.

    Article  PubMed  Google Scholar 

  • Dunkley, D. M., & Grilo, C. M. (2007). Self-criticism, low self-esteem, depressive symptoms, and over-evaluation of shape and weight in binge eating disorder patients. Behaviour Research and Therapy, 45, 139–149.

    Article  PubMed  Google Scholar 

  • Eisen, S. V., Toche-Manley, L. L., & Grissom, G. R. (2004). Computer-administered versus paper-and-pencil mental health surveys. Psychiatric Services, 55, 1316–1317.

    Article  PubMed  Google Scholar 

  • Errico, A. L., King, A. C., & Parsons, O. A. (1991). The influence of depressive symptomatology on alcoholics’ locus of control: A methodological note and a correction. Journal of Clinical Psychology, 47, 600–604.

    Article  PubMed  Google Scholar 

  • Fairburn, C. G., & Cooper, G. T. (1993). The eating disorder examination. In C. F. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment (pp. 317–332). New York: Guilford.

    Google Scholar 

  • Fairburn, C. G., Stice, E., Cooper, Z., Doll, H. A., Norman, P. A., & O’Connor, M. E. (2003). Understanding persistence in bulimia nervosa: A 5-year naturalistic study. Journal of Consulting and Clinical Psychology, 71, 103–109.

    Article  PubMed  Google Scholar 

  • Feingold, A., & Mazzella, R. (1998). Gender differences in body image are increasing. Psychological Science, 9, 190–195.

    Article  Google Scholar 

  • Fernandez-Aranda, F., Peri, J. M., Navarro, V., Badla-Casnovas, A., Turon-Gil, V., & Vallejo-Ruiloba, J. (2000). Transsexualism and anorexia nervosa: A case report. Eating Disorders, 8, 63–66.

    Article  Google Scholar 

  • Ferring, D., & Filipp, S.-H. (1996). Messungen des Selbstwertgefühls: Befunde zu Reliabilität, Validität und Stabilität der Rosenberg-Skala [Measurement of self-esteem: Findings on reliability, validity, and stability of the Rosenberg Scale]. Diagnostica, 42, 284–292.

    Google Scholar 

  • Fouladi, R. T., McCarthy, C. J., & Moller, N. P. (2002). Paper-and-pencil or online? Evaluating mode effects on measures of emotional functioning and attachment. Assessment, 9, 204–215.

    Article  PubMed  Google Scholar 

  • Freedman, R. (1990). Cognitive-behavioral perspectives on body image change. In T. F. Cash & T. Pruzinsky (Eds.), Body image: Development, deviance and change (pp. 272–295). New York: Guilford.

    Google Scholar 

  • Garner, D. M. (1991). Eating Disorder Inventory-2. Professional manual. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Garner, D. M. (1997). The 1997 body image survey results. Psychology Today, 30, 30–84.

    Google Scholar 

  • Halmi, K. A., Agras, W. S., Mitchell, J., Wilson, G. T., Crow, S., Bryson, S. W., et al. (2002). Relapse predictors of patients with bulimia nervosa who achieved abstinence through cognitive behavioral therapy. Archives of General Psychiatry, 59, 1105–1109.

    Article  PubMed  Google Scholar 

  • Hautzinger, M., Bailer, M., Worrall, H., & Keller, F. (2000). Beck-Depressions-Inventar (BDI). Testhandbuch (3. Auflage) [Beck Depression Inventory (BDI), manual (3rd ed.)]. Bern: Huber.

  • Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.

    Google Scholar 

  • Hepp, U., & Milos, G. (2002). Gender identity disorder and eating disorder. International Journal of Eating Disorders, 32, 473–478.

    Article  PubMed  Google Scholar 

  • Hilbert, A., Tuschen-Caffier, B., Karwautz, A., Niederhofer, H., & Munsch, S. (2007). Eating Disorder Examination–Questionnaire—Evaluation der deutschsprachigen Übersetzung Eating Disorder Examination-Questionnaire—Evaluation of the German translation. Diagnostica, 53, 144–154.

    Article  Google Scholar 

  • Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34, 383–396.

    Article  PubMed  Google Scholar 

  • Hospers, H. J., & Jansen, A. (2005). Why homosexuality is a risk factor for eating disorders in males. Journal of Social and Clinical Psychology, 24, 1188–1201.

    Article  Google Scholar 

  • Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 130, 19–65.

    Article  PubMed  Google Scholar 

  • Keel, P. K., Dorer, D. J., Franko, D. L., Jackson, S. C., & Herzog, D. B. (2005). Postremission predictors of relapse in women with eating disorders. American Journal of Psychiatry, 162, 2263–2268.

    Article  PubMed  Google Scholar 

  • Killen, J. D., Taylor, C. B., Hayward, C., Haydel, K. F., Wilson, D. M., Hammer, L., et al. (1996). Weight concerns influence the development of eating disorders: A 4-year prospective study. Journal of Consulting and Clinical Psychology, 64, 936–940.

    Article  PubMed  Google Scholar 

  • Kraemer, B., Delsignore, A., Schnyder, U., & Hepp, U. (2008). Body image and transsexualism. Psychopathology, 41, 96–100.

    Article  PubMed  Google Scholar 

  • McCreary, D. R., & Sasse, D. K. (2000). An exploration of the drive for muscularity in adolescent boys and girls. Journal of American College Health, 48, 297–304.

    Article  PubMed  Google Scholar 

  • Mitchell, J., & Crow, S. (2006). Medical complications of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 19, 438–443.

    Article  PubMed  Google Scholar 

  • Olivardia, R. (2001). Mirror, mirror on the wall, who’s the largest of them all? The features and phenomenology of muscle dysmorphia. Harvard Review of Psychiatry, 9, 254–259.

    PubMed  Google Scholar 

  • Olivardia, R. (2002). Body image and muscularity. In T. F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 210–218). New York: Guilford Press.

    Google Scholar 

  • Paul, T., & Thiel, A. (2005). EDI-2 Eating Disorder Inventory-2, Deutsche version, manual [EDI-2 Eating Disorder Inventory-2, German version, manual]. Göttingen: Hogrefe.

    Google Scholar 

  • Pauly, I. B., & Lindgren, T. W. (1976/1977). Body image and gender identity. Journal of Homosexuality, 2, 133–134.

    Google Scholar 

  • Reas, D. L., Whisenhunt, B. L., Netemeyer, R., & Williamson, D. A. (2002). Development of the Body Checking Questionnaire: A self report measure of body checking behaviors. International Journal of Eating Disorders, 31, 324–333.

    Article  PubMed  Google Scholar 

  • Riva, G., Teruzzi, T., & Anolli, L. (2003). The use of the internet in psychological research: Comparison of online and offline questionnaires. Cyber Psychology & Behavior, 6, 73–80.

    Google Scholar 

  • Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Russell, C., & Keel, P. (2002). Homosexuality as a specific risk factor for eating disorders in men. International Journal of Eating Disorders, 31, 300–306.

    Article  PubMed  Google Scholar 

  • Schneider, J. A., & Agras, W. S. (1987). Bulimia in males: A matched comparison with females. International Journal of Eating Disorders, 6, 235–242.

    Article  Google Scholar 

  • Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825–848.

    Article  PubMed  Google Scholar 

  • Sypeck, M. F., Gray, J. J., & Ahrens, A. H. (2004). No longer just a pretty face: Fashion magazines’ depictions of ideal female beauty from 1959–1999. International Journal of Eating Disorders, 36, 342–347.

    Article  PubMed  Google Scholar 

  • Taylor, M. J., & Cooper, P. J. (1992). An experimental study of the effect of mood on body size perception. Behaviour Research and Therapy, 30, 53–58.

    Article  PubMed  Google Scholar 

  • Tiggeman, M. (2004). Body image across the adult life span: Stability and change. Body Image, 1, 29–41.

    Article  Google Scholar 

  • Tomori, M., & Rus-Makovec, M. (2000). Eating behavior, depression, and self-esteem in high school students. Journal of Adolescent Health, 26, 361–367.

    Article  PubMed  Google Scholar 

  • Vocks, S., Legenbauer, T., Wächter, A., Wucherer, M., & Kosfelder, J. (2007). What happens in the course of body exposure? Physiological, cognitive and affective reactions to mirror confrontation in eating disorders. Journal of Psychosomatic Research, 62, 231–239.

    Article  PubMed  Google Scholar 

  • Vocks, S., Moswald, C., & Legenbauer, T. (2008). Psychometrische Überprüfung der deutschsprachigen Fassung des Body Checking Questionnaire (BCQ) [Psychometric revision of the German version of the Body Checking Questionnaire (BCQ)]. Zeitschrift für Klinische Psychologie und Psychotherapie, 37, 131–140.

    Article  Google Scholar 

  • Vocks, S., Wächter, A., Wucherer, M., & Kosfelder, J. (2008). Look at yourself: How does body image therapy affect emotional and cognitive reactions to seeing oneself in the mirror in eating disorders? European Eating Disorders Review, 16, 147–154.

    Article  PubMed  Google Scholar 

  • Waters, J. (1998). The razor edge: Walking the fine line of the self. In D. Atkins (Ed.), Looking queer: Body image and identity in lesbian, bisexual, gay and transgendered communities (pp. 181–187). Binghamton, NY: Haworth Press.

    Google Scholar 

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Correspondence to Silja Vocks.

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Vocks, S., Stahn, C., Loenser, K. et al. Eating and Body Image Disturbances in Male-to-Female and Female-to-Male Transsexuals. Arch Sex Behav 38, 364–377 (2009). https://doi.org/10.1007/s10508-008-9424-z

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