Eating Disorders in People Who Identify as Gender-Diverse: Associations Between Gender Diversity, Eating Disorder Diagnosis, Minority Stress Experiences and Mental Health Comorbidity

<b>Objective:</b> Mental health (MH) comorbidity is elevated in individuals who identify as gender-diverse (GD) and in individuals with an eating disorder (ED). GD individuals with an ED may have significantly higher MH comorbidity than individuals with just one of these conditions. Gender Minority Stress Theory suggests that experience of stressful events associated with gender minority status may increase risk of developing MH difficulties and may explain the elevated risk of ED diagnosis in GD populations. <b>Method:</b> This is a cross-sectional analysis of survey data. Using data from a sample of 334,957 American university and college students, we compared MH comorbidities of 1885 GD individuals with an ED to demographically matched samples of non-GD individuals with an ED and GD individuals with no ED diagnosis. <b>Results:</b> Even following stringent demographic matching, GD participants with an ED had significantly more comorbid MH diagnoses (M = 4.23, SD = 2.23) than non-GD individuals with an ED (M = 2.86, SD = 1.98). Similarly, GD participants with an ED had significantly higher MH comorbidity than demographically matched GD individuals without an ED (M = 1.96, SD = 1.84). In GD individuals, ED diagnosis was associated with increased odds of experiencing minority stress events (OR: 2.19 95% CI [1.91-2.51]) and associated distress (OR: 2.17 95% CI [1.89-2.50]). <b>Conclusions:</b> We find that GD individuals with an ED report significantly elevated MH comorbidity, including serious MH disorders. Prompt intervention and proactive screening have an important role to play in supporting young adults in this vulnerable population.