157. Disordered Eating in Transgender Youth: A Comparison to Population-Based and Clinical Samples


      Research suggests that transgender individuals are at heightened risk for gender-related body dissatisfaction and eating disorders (EDs). Eating disorders and gender-related body dissatisfaction often emerge and/or intensify during adolescence, due to the biological impacts of puberty in combination with other developmental and environmental influences that are prominent in adolescence. Despite the developmental importance of adolescence, much of the research on eating disorder symptoms in transgender individuals has focused on adult samples or combined adolescents with young adults. Further, while some small studies of transgender youth utilize validated ED measures, there are no studies in transgender youth that incorporate comparison groups to ascertain degree of risk compared to population-based samples or youth with ED diagnoses. Thus, the purpose of this study was to use a validated ED measure to examine disordered eating in transgender youth compared to a population-based sample and patients with a clinically diagnosed eating disorder (ED).


      Participants (ages 10-24 years) were a sample of patients (N = 19 transfeminine, 59 transmasculine, 14 nonbinary, 5 unknown gender identity) in a Midwestern pediatric gender clinic (N =97), a control sample of cisgender males (N = 42) and cisgender females (N = 58) obtained from the Michigan State University Twin Registry, and a sample of cisgender males (N = 6) and cisgender females (N = 85) enrolled in a Midwestern eating disorders program. Eating disorder attitudes and behaviors were assessed using the Eating Disorder Examination Questionnaire (EDE-Q) and compared across groups utilizing a one-way ANOVA.


      For all subscales of the EDE-Q, scores were lowest in the cisgender male control sample, followed by the cisgender female control sample, followed by the transgender sample, with scores in the eating disorder clinical sample being the highest. The one-way ANOVA indicated significant differences between groups for all subscales of the EDE-Q. Games-Howell post-hoc tests indicated that transgender participants had significantly higher scores on several EDE-Q subscales compared to the population-based control sample. However, scores in transgender participants were lower than in the eating disorder sample for the restraint, eating concern, weight concern, and global scales of the EDE-Q. (ps< .001), and approached being significantly lower for the shape concern subscale (p = .06).


      Preliminary evidence suggests that transgender youth report heightened ED cognitions compared to a control sample of youth in the general population, though scores are not as heightened as in cisgender individuals with clinical diagnoses of eating disorders. Findings underscore the importance of screening for ED symptoms in transgender youth and supports continued investigations of ED symptoms and potential unique treatment needs in this at-risk population.

      Sources of Support

      This study was supported by NIMH Grants R21MH070542 (PI: Nigg) and 1R03MH063851-01A1 (PI: Klump) and the Charles Woodson Children's Health Research Fund.