Role of gender in the treatment experiences of people with an eating disorder: a metasynthesis

Background: Traditionally perceived as a disorder of women, Eating Disorders (EDs) are known to have impacts on people irrespective of their gender. This study is designed to synthesise the available qualitative research studies to more broadly understand the diverse experiences of ED and their treatment, specifically in relationship to issues of gender. Methods: The methodology involved a systematic search and quality appraisal of the literature published after 1980 using terms that aimed to represent the primary concepts of role of gender and treatment experiences and eating disorders. Nine qualitative studies met the inclusion criteria. Meta-themes were inductively generated through a synthesis of data across themes from the relevant included papers. Results: Analysis of data was constructed around three meta-themes, each with subthemes. The first meta-theme Out of sight, out of mind depicted the experience of gender issues that were marginalised in treatment. More specifically for transgender people, when gender issues were ignored by treatment providers, this frequently led to non-disclosure of their gender identity. Furthermore, men were less likely to be assessed for an eating disorder and within this context; diagnosis of an ED and referral to specialist treatment was frequently hindered. The second meta-theme Lack of literacy among health care providers focused on issues related to misdiagnosis of EDs, and the question of whether this was related to a lack of health literacy amongst health professionals. The final theme Pathways into treatment that address stigma and other barriers highlighted the need for the development of future treatment interventions address the complex social reality of the experiencing person, including questions of gender. Conclusion: Gender issues impact upon the ED experience and require broader consideration in the development and evaluation of ED treatment interventions, including the further development of gender-informed interventions. Trial registration: Protocol registered on PROSPERO 2017 CRD42017082616.