Disordered eating in autistic trans and gender diverse people: a lived experience-led scoping review

TL;DR

This review explores high rates of eating disorders in autistic trans and gender diverse people, highlighting unique risk factors and the need for more research.

Contribution

The study is the first lived experience-led scoping review focusing on eating disorders in autistic trans and gender diverse populations.

Findings

Autistic trans and gender diverse people have high rates of eating disorders/disordered eating behaviors.

Atypical presentations of eating disorders may be more common in this population.

Risk factors include sensory hypersensitivity, co-occurring ADHD, gender dysphoria, and societal pressures.

Abstract

This lived experience-led scoping review explores the evidence base related to eating disorders/disordered eating behaviours in Autistic trans and gender diverse (TGD) people. This review highlights the currently available data on eating disorder prevalence rates, comparisons with allistic and cisgender groups, drivers and maintenance factors, the relationship between eating disorders and gender-affirming medical care, and treatment outcomes in this population.

We conducted a search of the databases ProQuest, Medline, CINAHL, Cochrane Library, Web of Science, Scopus, and PsycINFO for articles relating to eating disorders/disordered eating behaviours in Autistic TGD people. Five articles published between 2021 and 2025 met the criteria for the review.

The included articles were predominantly cross-sectional studies (n = 4) and one case series (n = 1). Researchers used a mixture of self-reported and clinically recorded eating disorder diagnoses, as well as validated measures, including the Eating Disorder Examination Questionnaire and the Nine-Item Avoidant/Restrictive Food Intake Disorder Scale. The literature highlights that the prevalence of eating disorders/disordered eating behaviours is high in the Autistic TGD population, and suggests that atypical presentations may be particularly common. Possible drivers and maintenance factors include sensory hypersensitivity, co-occurring Attention-Deficit Hyperactivity Disorder, gender dysphoria and passing concerns, and appearance pressures idealising thinness. Limited data were available on the role of gender-affirming medical care or eating disorder treatments, or on treatment outcomes.

Further research is needed to better understand the nuances of eating disorders/disordered eating behaviours in Autistic TGD people. Key to future research inquiries should be the adoption of an intersectional approach, co-production of research with Autistic TGD people, and research considering treatment outcomes.

We reviewed existing literature on eating disorders/disordered eating behaviours (EDs/DEBs) in Autistic trans and gender diverse (TGD) people. Five studies met our criteria. All were high-quality pieces published in the last five years. We found that Autistic TGD people have particularly high rates of EDs/DEBs and that atypical presentations may be more common. Autistic TGD people are exposed to the same risk factors for EDs/DEBs as the general population, which interact with TGD- and Autism-specific risk factors, co-occurring neurodivergence, and sensory processing differences. Evidence about treatment outcomes and the impact of gender-affirming medical care is limited. Given the additional and unique risks for EDs/DEBs in Autistic TGD people, more research is needed in this emerging field.

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