Transgender Mental Health: Offering Support - Zach Rawlings

October is National Coming Out Month so we are encouraging our trans friends to come out of the closet about their mental health issues and eating disorders this month. But we also encourage everyone else to do their part to make coming out easier. Zach Rawlings MA, LPC explains.

“I can’t help but ... wonder how my life might have been different ... if anyone who saw me in the course of my treatment had been able to recognize my gender dysphoria and inform me that there were ways of addressing my extreme discomfort with my post-pubertal body other than starving myself.”

The words above were spoken by a trans person formerly in eating disorder treatment. That sobering quote encapsulates what many in the trans community who battle an eating disorder —or another mental health issue— feel when they enter treatment.

Entering treatment is difficult enough. But, on top of that, many trans individuals have a list of other questions that weigh heavily on their mind before they muster the courage to make that first call to get help:

Have these doctors and psychologists treated a trans person before?
Will they try to blame my eating disorder on my gender identity?
Will they be more focused on my genitalia than my treatment?
What if the other people in treatment respond poorly to me?
Will I get bullied?

The list goes on. Sadly, many don’t get past these questions to make that initial call. One third of trans people avoid or postpone any healthcare completely because of these reasons (and many more). In fact, the trans community has struggled to get adequate healthcare for some time:

  • Trans folks are less likely to have health insurance and four times more likely to live in poverty compared to the general population
  • Less than five hours in medical school is devoted to LGBT health over all (some schools reported zero hours of training)
  • In one study, half of trans patients had to teach their doctors about transgender health issues at some point
  • Over 70% of trans people say they have experienced discrimination in the health care system. 

A hashtag, #transhealthfail, was recently created for trans folks to share their bad experiences with the healthcare system on Twitter. Thousands have posted to it lamenting their bad experiences.


























It’s a sad reality. And we at Eating Recovery Center, like other healthcare professionals, have made mistakes in our treatment of our trans patients throughout the years.
However, at ERC, we have taken steps to ensure that our clients who identify as a sexual or gender minority get the best care possible. Although all clients are different, we understand there are some unique factors that contribute to those who identify as transgender when it comes to mental health issues.
In their study on the experiences of trans clients in eating disorder treatment, Duffy, Henkel, and Earnshaw found that clinicians need to acknowledge the complex nature of the body in eating disorder treatment.























  • Some in the trans community might take steps to conform their body to their gender identity by trying to eliminate their curves or attempt to look more buff to “pass”
  • Some might want to be underweight or overweight to appear androgynous
  • Some use an eating disorder to avoid sexual objectification.

The reasons are many, but it’s important to acknowledge the complex role the body plays in a trans person’s treatment and recovery.
If you’re a concerned friend of someone who identifies as trans and you suspect they are suffering, reach out to them. Use the pronouns they prefer and apologize if you say the wrong thing. Ask questions and try to understand their experience.
If you’re a provider, please educate yourself so your clients don’t have to.
October is National Coming Out Month so we are encouraging our trans friends to come out of the closet about eating disorders and mental health issues this month. But we also encourage everyone else to do their part to make coming out with an eating disorder easier. 
We can make treatment more accessible for the trans community. But we need to educate ourselves first to make that initial step easier.

Zach Rawlings MA, LPC is a professional counselor, doctoral student, and mental health advocate. He’s a big fan of cool kicks, a good beat, and doing nothing—with people. You can learn more about his projects on TwitterFacebook and his website.

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