P4.067: Differences in prevalence of psychiatric comorbidities when comparing cisgender and transgender pediatric patients in eating disorder treatment

Background: Eating disorder prevalence is higher in transgender and gender diverse (TGD) youth compared to their cisgender peers. There is limited data on prevalence of psychiatric comorbidities like ADHD and OCD in pediatric patients with eating disorders when considering gender identity.

Methods: Pediatric patients who received care at an eating disorder clinic in Oregon from November 2020 through August 2024 with complete data were included in this analysis (n = 116). Patients were subsequently categorized by a combination of their gender identity and eating disorder diagnosis, with categories being: 1) cis females with anorexia nervosa-restricting subtype (AN-R), 2) cis females with anorexia nervosa-binge/purge subtype (AN-BP), 3) cis females with avoidant restrictive food intake disorder (ARFID), 4) cis males with AN-R, 5) cis males with AN-BP, 6) cis males with ARFID, 7) TGD youth with AN-R, 8) TGD youth with AN-BP, and 9) TGD youth with ARFID. Chi-square tests were conducted in R Studio to compare prevalence values for comorbidities by eating disorder diagnosis, gender identity, and across these 9 categories.

Results: The most prevalent eating disorder diagnosis in the sample was AN-R (44.8%). There was a significant difference in eating disorder prevalence by gender identity (p=0.02). AN-R was most prevalent in TGD youth (53.3%), where ARFID was most prevalent in cis males (52.2%). When considering psychiatric comorbidities by gender identity, there were significant differences in prevalence of ADHD (p=0.01) and ASD (p=0.02). Both ADHD and ASD were most prevalent in cis males, with prevalence values of 60.9% and 43.5%, respectively. When considering comorbidities by eating disorder diagnosis, there were significant differences in prevalence of ADHD (p=0.01), BPD (p=0.006), OCPD (p=0.005), and PTSD (p=0.01). ADHD was most prevalent in patients with ARFID (58.6%), BPD was most prevalent in patients with AN-BP (20.0%), OCPD was most prevalent in patients with AN-R (44.2%), and PTSD was most prevalent in patients with AN-BP (51.4%). When considering both gender identity and eating disorder diagnosis across the 9 categories, there were significant differences in prevalence of ADHD (p=0.03) and ASD (p=0.04). ADHD was most prevalent in TGD youth with ARFID (100.0%) and cis males with ARFID (75.0%), while ASD was most prevalent in cis males with AN-R (62.5%) and cis males with ARFID (41.7%).

Conclusion: Amongst pediatric patients with eating disorders, psychiatric comorbidity prevalence is higher than the general pediatric population. There are significant differences in psychiatric comorbidity prevalence when considering gender identity and eating disorder diagnosis. These differences are important to consider in both screening and treatment of pediatric patients receiving eating disorder treatment.