Examining Disordered Eating Behaviors Associated with Gender Dysphoria and Minority Stress among Transgender Adults in the Deep South

Abstract Introduction Transgender individuals experience more mental health challenges than their cisgender counterparts, including disordered eating. According to the Gender Minority Stress and Resilience model, proximal and distal stressors related to minoritized group identity contribute to health disparities, including disproportionate disordered eating prevalence. Research demonstrates that gender dysphoria, the distress resulting from incongruence between one’s gender and physical appearance, acts as a proximal stressor. However, no studies have tested whether distal minority stress and gender dysphoria relate to disordered eating among transgender adults. Methods Between 2016 and 2018, Southern U.S. transgender adults ( N = 60) completed surveys on transgender congruence, disordered eating, minority distal stress, and demographics. Multiple linear regression models and means testing examined relationships between minority stress, gender dysphoria, and disordered eating. Results 35% (21) of participants scored at or above the cutoff for disordered eating. Disordered eating was associated with gender dysphoria. Disordered eating cognitions related to increased gender dysphoria, transmasculine gender (compared to non-binary gender), and being white. Those with higher gender dysphoria, but lower distal stress, had greater odds of engaging in compensatory eating behaviors. Finally, individuals with a lower yearly income endorsed greater caloric restriction. Conclusions This is the first study to examine minority stress and gender dysphoria related to disordered eating in transgender adults. The study’s high prevalence of disordered eating suggests a need for improved screening and treatment when working with this population. Policy implications Legislative actions that support gender affirming care reduce rates of gender dysphoria and may, in turn, reduce disordered eating.