Client is a 15-year-old transgender male presenting for treatment with a history of Autism Spectrum Disorder and Obsessive-Compulsive Disorder, as well as rigid, “picky,” restrictive eating patterns. He reports significant Gender Dysphoria, which contributes to distress across multiple domains, but client finds connection at school with like-minded queer identifying kids. Clt experiences broader peer interactions as overwhelming and confusing, often describing difficulty interpreting implicit social norms.

Obsessive-compulsive symptoms are characterized by intrusive, repetitive thoughts that the client identifies as “psychotic” and he experiences these as difficult to disengage from. He attempts to manage distress through cutting and burning in addition to one past suicide attempt.

Clients also reports a history of trauma but states he is unable to recall any specific details before age seven.

Family is described as supportive and engaged in treatment. Parents demonstrate motivation to assist the client but present with elevated anxiety and a strong focus on academic performance and outcomes.

A few guiding points based on our discussion:

• How can the rigidity of ED treatment and professionals impact individualized care in a case like this?

• When working with gender dysphoria, how do you manage the political climate? The term “gender affirming” now has taken on various meanings. And in a case like this, how do you decipher when a client may be manipulating weight for gender presentation etc.

• Discussion of subtypes

• When does ERP need to be altered?

• What to do with a kid who may be of the TikTok generation and mimicking symptoms, or falling into the trend of ‘its cool to be depressed’?