Predictors of eating-related psychopathology in transgender and gender nonbinary individuals

Objective: Research examining the prevalence and severity of eating-related psychopathology in transgender and gender nonbinary individuals is limited. This study examined how identity development and minority stress relate to the presence of disordered eating behaviors and cognitions in transgender and gender nonbinary individuals, and improvement at one-year follow-up. Methods: Data come from a multi-site, longitudinal study of transgender and gender nonbinary individuals (n = 287) and includes assessment of transgender congruence, receipt of gender-affirming care, minority stress, and disordered eating symptoms. Hierarchical multivariable logistic regression was used to test for associations between identity development, minority stress, and eating-related psychopathology. Results: Eighty-three participants (28.9%) met criteria for current eating-related psychopathology. Loss of control eating was the most commonly endorsed behavior, followed by laxative, diuretic, or other medication use, and compulsive exercise. Higher transgender congruence was associated with lower odds of disordered eating symptoms (OR = 0.72, 95% CI 0.55-0.94), whereas increased internalized transphobia was associated with greater odds of disordered eating symptoms (OR = 1.41, 95% CI = 1.04-1.91). Participants with eating-related psychopathology had greater odds of having received gender-affirming psychotherapy in the year prior to assessment (OR = 2.33, 95% CI = 1.32-4.14). Conclusions: Results suggest that gender identity development and internalized transphobia are associated with eating-related psychopathology in transgender and gender nonbinary individuals. Mental health providers should consider assessing all transgender and gender nonbinary individuals for eating-related psychopathology and unique risk factors associated with disordered eating, including low transgender congruence and internalized transphobia.