Exploring Associations between Body Image Satisfaction and Disordered Eating Attitudes and Behaviors among Transgender and Gender Diverse Young Adults

Purpose: This study was designed to explore associations between body image satisfaction and aspects of gender congruence that relate to eating attitudes and behaviors among transgender young adults. Methods: Participants’ demographic data, body mass index, and ability to access gender-affirming hormones, along with the validated Body Image Scale (BIS), Family Gender Environment (FGE), and Transgender Congruence Scale (TCS) were analyzed from 82 transgender participants —24 transgender male, 27 transgender female, and 31 nonbinary individuals aged 18–26, surveyed in 2024. The primary outcome was disordered eating attitudes and behaviors as measured by the Eating Disorders Examination Questionnaire (EDE-Q) total score. Results: Forty-four percent of respondents indicated a history of eating disorders. Lower TCS total scores (OR = 0.53, p = 0.04) and higher scores on FGE exclusion and abuse subscale (OR = 2.03, p = 0.03) were associated with increased odds of reporting an eating disorder history. EDE-Q scores were associated with TCS total score (β = −0.51; p = 0.02); the FGE scales on exclusion and abuse (β = 0.72; p = 0.002), changing gender expression (β = 0.62; p = 0.004), and viewing gender as a moral wrong (β = 0.60; p = 0.002); the BIS secondary subscale (β = 1.10; p < 0.001), and BMI (β = 0.04; p = 0.03). Conclusions: Disordered eating attitudes and behaviors were found to be highly prevalent among a sample of the transgender population. These behaviors were heavily influenced by body image, gender congruence, negative family support, and other aspects of gender identity and affirmation.