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

Examining Disordered Eating Behaviors Associated with Gender Dysphoria and Minority Stress among Transgender Adults in the Deep South | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Examining Disordered Eating Behaviors Associated with Gender Dysphoria and Minority Stress among Transgender Adults in the Deep South Elliott Botelho, Alena C. Borgatti, Sierra T. Carrera, Rory Edwards, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7093701/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Oct, 2025 Read the published version in Sexuality Research and Social Policy → Version 1 posted You are reading this latest preprint version 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 2016-2018, 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. transgender health disordered eating gender dysphoria gender minority stress discrimination 1. Introduction As a minoritized group, transgender individuals face a unique set of stressors related to health disparities, including gender dysphoria, discrimination, and the internalization of society's beliefs and prejudices (Hendricks & Testa, 2012 ; Lindley & Galupo, 2020 ). These stressors impact physical and mental health, including disordered eating, which is disproportionately prevalent in transgender populations (Nagata et al., 2020 ; Testa et al., 2017 ). In one national study of college-aged individuals, 15.8% of transgender people had a diagnosed eating disorder, compared to 1.5% overall (Diemer et al., 2015 ). More recent prevalence estimates suggest that disordered eating, which includes both diagnosable eating disorders as well as subthreshold disordered eating symptoms, were present among roughly 22–35% of transgender individuals (Romano & Lipson, 2021 ; Testa et al., 2017 ). Several unique factors may drive the development of disordered eating in transgender people. Gender dysphoria can relate to appearance or social perception, but often centers around primary and secondary sex characteristics (Galupo et al., 2020 ). Previous research suggests gender-affirming medical care can successfully alleviate gender dysphoria and improve quality of life; moreover, these interventions predict increased body satisfaction and decreased disordered eating (Testa et al., 2017 ; van Leerdam et al., 2021 ). Unfortunately, not all individuals are able to pursue transition steps, particularly in the Southeastern United States where gender-affirming care options are under increasing political attack, including a recent total ban on gender affirming care for minors in Tennessee that has been upheld by the U.S. supreme court (Band et al., 2025 ; Chin et al., 2024 ; Sosa, 2025 ; United States v . Skrmetti, 2025 ). Inability to access gender-affirming care may increase the risk of “compensatory conditions” to mitigate negative body image and body dissatisfaction (Brownstone et al., 2021 ; Diemer et al., 2015 ; Nolan et al., 2019 ). Body image and gender are intertwined for many (i.e., “passing,” or being perceived in a gender-affirming way by others), and these individuals may engage in disordered eating to feel more affirmed in their bodies, or to exercise control over their bodies and circumstances (Cusack, Iampieri, et al., 2022). Conversely, passing as one’s gender may also be protective against disordered eating; for some individuals, feelings of passing increase self-esteem and body satisfaction, which are inversely related to disordered eating (Baranowksi et al., 2003 ; Owen-Smith et al., 2018 ). Passing may also decrease discrimination and stigma experiences, which can in turn reduce external stress contributing to disordered eating (Diemer et al., 2018 ; Testa et al., 2017 ). Gender identity and assigned sex may also impact disordered eating. Being assigned female at birth increases risk for disordered eating, regardless of gender (Witcomb et al., 2015 ). However, findings regarding the role of gender are more unclear, suggesting non-binary individuals may be more frequently diagnosed with an eating disorder, but also have higher rates of body satisfaction (Diemer et al., 2018 ; Jones et al., 2019 ). One potential explanation for this relationship is that non-binary people experience more stigma and discrimination (especially those who do not "pass" as a binary gender), which may increase disordered eating (Diemer et al., 2018 ; Nagata et al., 2020 ). 1.1 Gender Minority Stress and Resilience The Gender Minority Stress and Resilience Model posits that discrimination and stigma may contribute to health disparities among transgender individuals (Hendricks & Testa, 2012 ). This includes distal stressors, or external events that occur when interacting with one’s environment, and proximal stressors, which reflect internalized transnegative attitudes and the anticipation of distal stressors. Gender dysphoria is considered a proximal stressor, and has been correlated with anticipated stigma (Lindley & Galupo, 2020 ). External stressful events also trigger concerns of the stressor reoccurring (e.g., increased vigilance), and simultaneously contribute to internalized negative societal attitudes; together, these are thought to result in poorer mental health outcomes (Meyer, 2003 ). 1.1.1 Anti-Transgender Policies and the Southeastern United States Since 2019, record numbers of anti-transgender policies and legislation have been introduced in the United States, demonstrating the pervasiveness of systemic oppression and marginalization of transgender people (Lavietes & Ramos, 2022 ). As of June 2025, the American Civil Liberties Union (ACLU) has monitored a record-breaking 588 anti-transgender bills that have been introduced across the country, with 59 having passed into law (American Civil Liberties Union, 2025 ). These policies span both the state and federal level, and include a series of Presidential Executive Orders targeting transgender individuals’ right to access gender-affirming healthcare or obtain federal documentation of citizenship (i.e., passport) with their gender, rather than assigned sex at birth, accurately reflected (Exec. Order No. 14187, 2025; Exec. Order No. 14187, 2025; Exec. Order No. 14201, 2025). In addition to this federally-condoned discrimination, transgender individuals experience disproportionate stressors and barriers in the Southeastern United States (frequently referred to as the “Deep South”), such as discriminatory interpersonal interactions and limited availability of gender-affirming providers (Botelho et al., 2024 ). Moreover, nearly all Southeastern states have policies that reduce protections or outright restrict the rights of transgender individuals (Movement Advancement Project, 2025 ). However, this is a limited proxy for how transgender people live in the Deep South, interact with their environment, and how that environment contributes to distal and proximal stress that may exacerbate pre-existing mental health disparities. Despite this ever-growing concern, research on transgender people living in the Deep South is limited. 1.2 Present Study The present study is, to our knowledge, the first study to examine disordered eating among transgender people in the Deep South, and the first to examine gender dysphoria and distal stress among transgender individuals in relation to disordered eating. Relationships between gender dysphoria, minority stress, and disordered eating were evaluated, while examining how sociodemographic differences contribute to disordered eating within the transgender community. We hypothesized that greater gender dysphoria and distal minority stress would correlate with increased disordered eating. Further, we explored sociodemographic differences in disordered eating. Finally, ad hoc exploratory analyses for each aim tested whether distal stress and gender dysphoria were related to specific categories of disordered eating symptoms. 2. Methods The Institutional Review Board at MASKEDFORREVIEW approved the present study on May 21, 2019 (protocol #IRB-300002672). Informed consent was obtained electronically via Qualtrics, and participants’ privacy was maintained throughout the study. 2.1 Participants Participants ( N = 60) were recruited via community and campus advertising in two mid-sized Southeastern U.S. cities between 2016–2018. Individuals were compensated via gift card, and recruited through local gender-affirming providers, university campus advertisements, social media websites, and respondent-driven sampling. Participants were transgender and/or gender non-conforming and ≥ 18 years old. 2.2 Measures 2.2.4 Demographic Information Participants provided demographic information, including family income level, race/ethnicity, and age. Income and race/ethnicity were both collected via multiple-choice categorical responses, and dichotomized due to sample size. Gender identity was collected via multiple-choice item, allowing participants to select from a list of options or provide an open response. Due to sample size, these selections were recoded into three categories: transmasculine (including transgender men), non-binary, and transfeminine (including transgender women). 2.2.1. Transgender Congruence Scale (TCS) – Appearance Subscale The TCS is a 15-item Likert-style scale measuring individuals’ comfort with their gender identity and appearance (Kozee et al., 2012 ). Scale items are reverse-scored, with higher scores indicating more gender dysphoria (e.g., gender incongruence). The TCS has previously demonstrated strong construct validity; in the present study, the appearance subscale demonstrated good internal consistency (α = .83). 2.2.2 Eating Disorder Diagnostic Scale (EDDS) The EDDS is a 22-item Likert-style scale which asks individuals about food, weight, and eating-related thoughts within the preceding three months, as well as the weekly frequency of disordered eating behaviors (Stice et al., 2000 ). Higher scores suggest greater eating disorder symptomatology. Disordered eating cognitions, caloric restriction, binge eating, and compensatory behaviors (e.g., purging) were also specifically studied. Within the sample, the EDDS composite had good internal consistency (α = .82), while the cognitive distortion and binge eating subscales demonstrated adequate internal consistency (both α = .78). Compensatory behaviors did not present as a unified subscale (α=-.14), with most individuals reporting only one compensatory behavior. As such, compensatory behaviors were operationalized as a singular variable reflecting participants’ endorsement of any compensatory behavior. Additionally, caloric restriction is a single Likert scale item; as such, measures of internal consistency are not available. 2.2.3 Gender Minority Stress and Resilience Measure – Distal Stress Subscales The Gender Minority Stress and Resilience Measure contains nine subscales assessing components of gender minority stress and resilience (Testa et al., 2015 ). Distal stressors include gender-related discrimination, rejection, victimization, and non-affirmation of gender identity. Previous research summed proximal stressors into a single scale, with confirmatory factor analyses supporting this approach (Lindley & Galupo, 2020 ). While evidence supporting a unitary distal stress construct remains unclear, distal stress subscales were summed given the study sample size. This composite showed good internal consistency (α = 0.88). 2.3 Data Analysis Data were analyzed using SPSS and RStudio. Missing data were addressed via Random Forest multiple imputation, a method considered appropriate and reliable for psychological research (Golino & Gomes, 2016 ). Regression procedures evaluated relationships between gender dysphoria, distal minority stress, and disordered eating. Bivariate correlations assessed for multicollinearity of gender dysphoria and distal stress subscales to ensure both could be included in a single model. Gender dysphoria and minority stress served as independent variables, with disordered eating scores as the dependent variable. Analyses controlled for age, income, and race, utilizing a Bonferroni correction to protect against Type I error. Due to sample size, omnibus and individual effects were assessed for each of the tested models. Additionally, as disordered eating behaviors vary across different diagnoses, a series of ad hoc regressions tested these same variables in relation to disordered eating subscales. Linear regressions assessed caloric restriction, binge eating, and disordered eating cognition subscales; however, as compensatory behaviors were binarized by the presence or absence of symptoms, a logistic regression was used to assess whether symptoms were associated with increased odds of compensatory behavior engagement. A power analysis indicated the study was adequately powered, needing 52 participants to achieve .8 power. 3. Results 3.1 Study Sample Participants were predominantly white (85%) and most earned under $10,000 annually (57%). See Table 1 for complete sample demographics and Table 2 for inter-variable correlations. 3.2 Disordered Eating 35% ( n =21) of participants scored at or above the cutoff score (Krabbenborg et al., 2012) for an eating disorder. Further, 28% of participants reported clinically significant levels of disordered eating cognitions, 15% endorsed compensatory behaviors, 40% reported weekly binge eating, and 27% skipped multiple consecutive meals to influence their weight. 3.3 Disordered Eating, Gender Dysphoria, and Distal Stress Gender dysphoria and distal stress were correlated, but not multicollinear, in bivariate correlations (r(59)=0.420, p <0.001). When controlling for age, race, and income, the omnibus F test of the overall model assessing disordered eating was not significant, R 2 =.10, F (5,52.11)=1.249, p= 0.30. Two ad hoc sensitivity analyses were performed, one evaluating the inclusion of gender, and the other without demographic covariates; these did not alter significance. At the individual results level and across all three models, a significant positive association emerged between gender dysphoria and disordered eating ( p 0.05). 3.3.1 Exploratory Subscale Analyses A series of exploratory, ad hoc regressions examined associations between gender dysphoria, distal minority stress, and demographic factors on four disordered eating subscales: disordered eating cognitions, binge eating, compensatory behaviors, and caloric restriction. Individuals with greater gender dysphoria, who were transmasculine (as opposed to non-binary), and were white had greater disordered eating cognitions ( R 2 =.30, F (7,50.109)=3.23, p= 0.007; Table 3). The odds of endorsing compensatory behaviors were increased for individuals who were white, younger, and reported greater gender dysphoria, less distal stress, and lower income ( F (6,50.12)=5.94, p <.001; Table 4). Moreover, gender was associated with compensatory behaviors, wherein transmasculine individuals were more likely to report compensatory behaviors than non-binary or transfeminine individuals, but transfeminine and non-binary individuals did not differ in their likelihood of engaging in compensatory behaviors. The omnibus F test examining the relationship between caloric restriction and the variables of interest was not significant, R 2 =.17, F (7,44.05)=1.114, p= 0.37. However, lower income was related to increased caloric restriction ( b =-1.52, p =.04). Binge eating was not associated with any variables of interest, R 2 =.09, F (7,50.11)=.75, p= 0.64. 4. Discussion The present study explored associations between minority stress, gender dysphoria, and disordered eating in two mid-to-large cities in the Deep South. It also compared disordered eating across age, income, race/ethnicity, and gender. To date, few studies have evaluated these factors in the context of the Gender Minority Stress and Resilience Theory, especially among residents of the Deep South (Hendricks & Testa, 2012). Disordered eating behaviors were present in a large proportion (35%) of the sample, consistent or slightly elevated compared to prior studies (22-35%; Romano & Lipson, 2021; Testa et al., 2017). While direct sample comparisons were not available and sample size precludes determining whether this constitutes a meaningful difference, certain regional and sample differences may relate to this variability in prevalence. This may include systemic and intersectional contributors to discrimination and poor health, such as anti-transgender legislation efforts, stricter societal norms around gender contributing to increased dysphoria, limited access to gender affirming care and mental healthcare within the region or due to income, food insecurity, and instability secondary to low income. Nearly 60% of the current sample had an annual income under $10,000, further highlighting the pervasive systemic inequities within the region and the unique burden experienced by this group relative to many other research samples in the broader disordered eating literature (Halbeisen et al., 2022). To our knowledge, this is the first study to examine disordered eating among transgender people in the Deep South, a population subjected to high levels of gender minority stressors at interpersonal and systemic levels (Botelho et al., 2024). 4.1 Disordered Eating Symptom Correlates: Composite Symptoms The hypothesis that disordered eating would correlate with gender dysphoria and distal stress was partially supported; on the composite measure, disordered eating was associated with gender dysphoria, although distal stress was not. There are a number of possible explanations for this finding. First, it is possible that individuals experiencing gender dysphoria may engage in disordered eating to help manage dysphoria, whereas distal stressors do not prompt this same response. It is also possible that distal stressors may be ever-present for transgender individuals, precipitating gender dysphoria, but not the internalization of transnegativity or translation into disordered eating. Alternatively, since disordered eating is often conceptualized as a set of internalizing behaviors (Forbush et al., 2017), there may be an underlying propensity for internalization that contributes to both gender dysphoria and disordered eating (Brewster et al., 2019). It is also possible that the present model does not account for modifying factors, such as pride in one’s identity (Hendricks & Testa, 2012; Testa et al., 2015), which may reduce the impact of factors that result in poorer outcomes (i.e., disordered eating). Composite disordered eating did not differ across income, race, or age, a significant departure from previous research (Mitchison et al., 2014; Mulders-Jones et al., 2017; Sonneville & Lipson, 2018; Stice et al., 2000; Testa et al., 2017; Udo & Grilo, 2018; Witcomb et al., 2015) . This deviation from prior findings may be related to the study’s smaller sample, participants’ socioeconomic status (i.e., 57% with under $10,000 annual income), and overrepresentation of white participants. 4.2 Disordered Eating Symptom Clusters 4.2.1 Correlates of Cognitive Distortions Disordered eating cognitions correlated with gender dysphoria, being white, and being transmasculine. As data were collected cross-sectionally, the exact process through which disordered eating and gender dysphoria are related is unknown. For example, individuals may focus on body shape or weight as a gendered experience, thus impacting how they view their size; alternatively, increased disordered eating cognitions may lead to more body consciousness, thereby increasing gender dysphoria. This is in line with prior qualitative studies which suggest that for many individuals, body image and gender are deeply intertwined (Pulice-Farrow et al., 2020). In our study, transmasculine individuals endorsed more disordered eating cognitions than non-binary individuals, but not transfeminine individuals; notably, prior findings suggest that individuals assigned female at birth exhibit higher rates of disordered eating than their counterparts, accounting for their gender (Witcomb et al., 2015). While some prior studies suggest that non-binary individuals have more body satisfaction and less disordered eating, other studies suggest the stigma of gender nonconformity could increase risk of disordered eating (Diemer et al., 2018; Jones et al., 2019). Previous research suggests that non-binary people do not feel that established, assigned sex-specific gender dysphoria measurement scales accurately capture their experiences(Galupo & Pulice-Farrow, 2020). Thus, perhaps the experiences of non-binary people are qualitatively different from binary transgender individuals, and this difference may buffer against disordered eating cognitions. The present study utilized the TCS, a broad measure of gender congruence, to quantify gender dysphoria as opposed to an assigned sex-specific measure; this is a strength of the present study and likely reduced measurement error between binary and non-binary individuals. 4.2.2 Correlates of Compensatory Behaviors Compensatory behaviors positively correlated with gender dysphoria, consistent with previous literature (Diemer et al., 2015; Kozee et al., 2012; van de Grift et al., 2016). Interestingly, distal stress was negatively associated with compensatory behaviors. This effect was lessened in bivariate correlations, suggesting that other factors (e.g., age, race, income, or gender dysphoria) may influence distal stress and compensatory behaviors. This is further supported by the significant associations between compensatory behaviors and other variables within the model (i.e., income, gender). Perhaps individuals have separate regulation mechanisms for experiences of discrimination, violence, and non-affirmation, or unassessed latent variables moderate this relationship, such as emotion regulation, gender minority resilience, or trait internalizing (Brewster et al., 2019; King et al., 2020). As resilience may buffer against adverse physical and mental health outcomes (Hendricks & Testa, 2012), future studies should examine whether resilience might potentially reverse associations between distal stress and compensatory behaviors, a finding supported by prior literature demonstrating negative corollary relationships between distal stressors and resilience factors (Breslow et al., 2015). Given the negative Cronbach’s 𝛼, the compensatory behavior model used a categorical outcome variable indicating whether participants had endorsed any compensatory behaviors. Similarly, future research may consider creating a singular variable representative of any endorsement of compensatory behavior, since individuals with purging behaviors often endorse a singular method of choice (rather than multiple; Haedt et al., 2006; Schaumberg et al., 2014). 4.2.3 Correlates of Caloric Restriction While the overall model was non-significant, caloric restriction was significantly associated with lower yearly income, consistent with previous literature (Testa et al., 2017). This could be related to food insecurity, continuing stressors of living in severe poverty, or a way to manage gender dysphoria when affordable gender-affirming healthcare is otherwise unavailable. 4.3 Implications for Clinical Practice This study highlights the high prevalence of disordered eating among transgender individuals, reinforces the need for further research into disordered eating among the transgender community, and emphasizes the importance of policies that may mitigate gender dysphoria, including gender affirming healthcare. Although the sample is smaller, the high prevalence of disordered eating is alarming and reinforces the need for tailored disordered eating screening and prevention efforts for those experiencing gender dysphoria. Additional studies of transgender individuals in the Deep South are important to explore how the regional environment may impact health; qualitative work could be especially helpful for identifying relevant risk factors. The high prevalence of disordered eating within the sample highlights a need for screening and intervention. Clinicians should consider how gender dysphoria and disordered eating cognitions interact when working with clients, particularly transmasculine individuals. For transgender clients who have undergone eating disorder treatment, processing gender dysphoria and unpacking gender role socialization expectations have been reported as beneficial aspects of treatment (Cusack, Levenson, et al., 2022). However, infusing stereotypes about transgender individuals into eating disorder treatment (e.g., eating disorders develop because a person is transgender) were considered unhelpful (Cusack, Levenson, et al., 2022). Given the limited study of disordered eating among transgender individuals, as well as variable mechanisms through which gender dysphoria may impact disordered eating, clinicians should avoid introducing reductionist etiological stereotypes into treatment (e.g., that gender dysphoria is the sole cause of a client’s disordered eating). Clinicians must also remember that they often serve as gatekeepers to accessing gender-affirming care when such care is available, and prioritizing a single narrative of transitioning may perpetuate the transnormative binary medical model (and possibly, by extension, disordered eating) in healthcare systems while also reducing access. 4.4. Policy Implications Gender dysphoria was associated with disordered eating within the current sample, and past research has demonstrated that gender-affirming care improves quality of life, decreases gender dysphoria, and decreases disordered eating (Murad et al., 2010; Testa et al., 2017). In recent years, there has been a dramatic and pervasive increase in anti-transgender legislation and policy, which has created a hostile sociopolitical climate for transgender individuals (Lavietes & Ramos, 2022). These policies have only increased in 2025, including a series of Presidential Executive Orders targeted at defining sex and gender as binary and equal, rather than a spectrum or a state that may change over time (Exec. Order No. 14187, 2025). While these policy guidelines affect all transgender people, they have a unique effect on non-binary individuals, who may not wish to pass as or conform to one binary gender. Policymakers and advocates must seek to enshrine into legislation the difference between sex and gender, as well as recognizing the existence of non-binary genders. Moreover, policy that protects the transgender community’s right to accurate and updated social and legal identification throughout the United States, at both the state and federal levels, may reduce gender dysphoria and improve mental health (Restar et al., 2020). Concerningly, the Trump Administration’s Executive Order #14187 (Exec. Order No. 14187, 2025) specifically discredits the World Professional Association of Transgender Health’s Standards of Care (WPATH SOC), which are widely regarded as best practices for working with transgender individuals in healthcare settings and reflect findings of over 1,500 peer-reviewed manuscripts and studies (Coleman et al., 2022). Given the relationship between disordered eating and gender dysphoria, eating disorder professionals specifically should be called on to reaffirm these gold standard and evidence-based guidelines and reject efforts to binarize gender or restrict gender affirming care, as this federal guidance may increase gender dysphoria and disordered eating, adding strain to a healthcare sector that is already severely challenged by unmet treatment needs (Striegel Weissman & Rosselli, 2017). 4.5 Limitations The present study has several key limitations. Participants were predominantly white, and only sampled from two Southern states, without the ability to control for urbanicity or rurality within analyses. Additionally, information and strength of relationships on sociodemographic differences should be interpreted with caution, given that most individuals reported a family income well below established poverty levels. Thus, true differences may be obscured by the homogeneity of the present sample. In addition, moderate quantities of missing data (44.8% cases with any missing data, 17.7% missing data points), combined with the small sample size, necessitated imputation procedures before data analysis. Thus, limitations to generalizability should be strongly considered in the context of these sample parameters. Furthermore, the sample size precluded the examination of interactions between assigned sex at birth and gender, and limited our ability to examine the association between income and other variables of interest in a trichotomous format. As such, effects related to assigned sex or income may have been masked within the data. 4.6 Conclusions Transgender individuals experience more health challenges than their cisgender counterparts, including increased risk of experiencing disordered eating. The current study revealed a high rate of disordered eating within a sample of transgender adults within the Deep South, as well as associations between disordered eating and gender dysphoria, distal stress, gender, race, and income. Identifying unique factors associated with the development of disordered eating within this population not only adds to the literature regarding these topics, but may also have critical clinical and policy implications for transgender adults living within the Deep South . Declarations Funding: This work was supported, in part, by the Malyon-Smith Scholarship Award sponsored by Division 44 of the American Psychological Association (APA), grant F31AA024685 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Thomas Fellowship awarded to the last author. The first author is supported by grant T32HS013852 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of APA Division 44, the NIAAA, the NIDDK, National Institutes of Health, the Thomas family, or the Agency of Healthcare Research and Quality. Conflicts of Interest: None Availability of data and material: Due to the small sample size of this data and risk of participant identification via the data, the data utilized in the present study are not publicly available. Questions regarding the data or its use should be directed to the corresponding author. Code Availability: Not Applicable. Acknowledgments: We would like to thank Gregory L. Stuart for his guidance in acquiring funding for the parent study, Drs. Leticia Flores and Rebecca Morgan for recruitment assistance, and Drs. Andres Azuero and Edwin W. Cook III for their guidance in statistical methodology. Author Contribution All authors contributed to study conceptualization. E.B. completed study conceptualization, methodology, formal analysis, and original draft writing. CWC completed study conceptualization, funding acquisition, investigation, writing – review and editing, supervision. A.B. completed revisions to writing and preparation for submissions. R.E., S.T.C, and N.S.S. were involved in data curation and revising manuscript drafts. References American Civil Liberties Union. (2025). Legislative Attacks on LGBTQ Rights—2025 . American Civil Liberties Union. https://www.aclu.org/legislative-attacks-on-lgbtq-rights-2025 Band, I. C., Dubois, B., Ghofranian, A., Nietsch, K. S., Lee, J. A., Friedenthal, J., Copperman, A. B., & Estevez, S. L. (2025). An Analysis of Gender-Affirming Care Offerings on United States Pediatric Hospital Websites: Exploring the Impact of State Legislative Bans. LGBT Health , lgbt.2024.0214. https://doi.org/10.1089/lgbt.2024.0214 Baranowksi, M. J., Jorga, J., Djordjevic, I., Marinkovic, J., & Hetherington, M. M. (2003). Evaluation of adolescent body satisfaction and associated eating disorder pathology in two communities. European Eating Disorders Review , 11 (6), 478–495. https://doi.org/10.1002/ERV.529 Botelho, E., Goldbach, C., Johnson, A. H., & Crockett, K. B. (2024). “[Being] Trans Is So Much More Than Medical Models”: A Qualitative Examination of Transgender Adults’ Healthcare Experiences in the Southeastern United States. Annals of LGBTQ Public and Population Health , LGBTQ-2023-0041.R1. https://doi.org/10.1891/LGBTQ-2023-0041 Breslow, A. S., Brewster, M. E., Velez, B. L., Wong, S., Geiger, E., & Soderstrom, B. (2015). Resilience and Collective Action: Exploring Buffers Against Minority Stress for Transgender Individuals. Psychology of Sexual Orientation and Gender Diversity , 2 (3), 253–265. https://doi.org/10.1037/sgd0000117 Brewster, M. E., Velez, B. L., Breslow, A. S., & Geiger, E. F. (2019). Unpacking body image concerns and disordered eating for transgender women: The roles of sexual objectification and minority stress. Journal of Counseling Psychology , 66 (2), 131–142. https://doi.org/10.1037/cou0000333 Brownstone, L. M., Kelly, D. A., Maloul, E. K., Dinneen, J. L., Palazzolo, L. A., Raque, T. L., & Greene, A. K. (2021). “It’s just not comfortable to exist in a body”: Transgender/gender nonbinary individuals’ experiences of body and eating distress during the COVID-19 pandemic. Psychology of Sexual Orientation and Gender Diversity . https://doi.org/10.1037/sgd0000519 Chin, M. G., LaGuardia, J. S., Morgan, K. B. J., Ngo, H., Moghadam, S., Huang, K. X., Bedar, M., Cronin, B. J., Kwan, D., & Lee, J. C. (2024). United States Health Policies on Gender-Affirming Care in 2022. Plastic & Reconstructive Surgery , 153 (2), 462e–473e. https://doi.org/10.1097/PRS.0000000000010594 Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., … Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health , 23 (sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644 Cusack, C. E., Iampieri, A. O., & Galupo, M. P. (2022). “I’m still not sure if the eating disorder is a result of gender dysphoria”: Trans and nonbinary individuals’ descriptions of their eating and body concerns in relation to their gender. Psychology of Sexual Orientation and Gender Diversity . https://doi.org/10.1037/sgd0000515 Cusack, C. E., Levenson, N. H., & Galupo, M. P. (2022). “Anorexia Wants to Kill Me, Dysphoria Wants Me to Live”: Centering Transgender and Nonbinary Experiences in Eating Disorder Treatment. Journal of LGBTQ Issues in Counseling , 16 (3), 265–284. https://doi.org/10.1080/26924951.2022.2054492 Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal of Adolescent Health , 57 (2), 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003 Diemer, E. W., Hughto, J. M. W., Gordon, A. R., Guss, C., Austin, S. B., & Reisner, S. L. (2018). Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. Transgender Health , 3 (1), 17. https://doi.org/10.1089/TRGH.2017.0043 Exec. Order No. 14187, 3 C.F.R. (2025). Exec. Order No. 14201, Executive Order, 3 C.F.R. (2025). Forbush, K. T., Hagan, K. E., Kite, B. A., Chapa, D. A. N., Bohrer, B. K., & Gould, S. R. (2017). Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. Comprehensive Psychiatry , 79 , 40–52. https://doi.org/10.1016/j.comppsych.2017.06.009 Galupo, M. P., & Pulice-Farrow, L. (2020). Subjective Ratings of Gender Dysphoria Scales by Transgender Individuals. Archives of Sexual Behavior , 49 (2), 479–488. https://doi.org/10.1007/s10508-019-01556-2 Galupo, M. P., Pulice-Farrow, L., & Lindley, L. (2020). “Every time I get gendered male, I feel a pain in my chest”: Understanding the social context for gender dysphoria. Stigma and Health , 5 (2), 199–208. https://doi.org/10.1037/sah0000189 Golino, H. F., & Gomes, C. M. A. (2016). Random forest as an imputation method for education and psychology research: Its impact on item fit and difficulty of the Rasch model. International Journal of Research & Method in Education , 39 (4), 401–421. https://doi.org/10.1080/1743727X.2016.1168798 Haedt, A. A., Edler, C., Heatherton, T. F., & Keel, P. K. (2006). Importance of multiple purging methods in the classification of eating disorder subtypes. International Journal of Eating Disorders , 39 (8), 648–654. https://doi.org/10.1002/eat.20335 Halbeisen, G., Brandt, G., & Paslakis, G. (2022). A Plea for Diversity in Eating Disorders Research. Frontiers in Psychiatry , 13 , 820043. https://doi.org/10.3389/fpsyt.2022.820043 Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice , 43 (5), 460–467. https://doi.org/10.1037/a0029597 Jones, B. A., Pierre Bouman, W., Haycraft, E., & Arcelus, J. (2019). Gender congruence and body satisfaction in nonbinary transgender people: A case control study. International Journal of Transgenderism , 20 (2–3), 263–274. https://doi.org/10.1080/15532739.2018.1538840 King, K. M., Feil, M. C., Halvorson, M. A., Kosterman, R., Bailey, J. A., & Hawkins, J. D. (2020). A trait-like propensity to experience internalizing symptoms is associated with problem alcohol involvement across adulthood, but not adolescence. Psychology of Addictive Behaviors , 34 (7), 756–771. https://doi.org/10.1037/adb0000589 Kozee, H. B., Tylka, T. L., & Bauerband, L. A. (2012). Measuring Transgender Individuals’ Comfort With Gender Identity and Appearance: Development and Validation of the Transgender Congruence Scale. Psychology of Women Quarterly , 36 (2), 179–196. https://doi.org/10.1177/0361684312442161 Krabbenborg, M. A. M., Danner, U. N., Larsen, J. K., van der Veer, N., van Elburg, A. A., de Ridder, D. T. D., Evers, C., Stice, E., & Engels, R. C. M. E. (2012). The Eating Disorder Diagnostic Scale: Psychometric Features Within a Clinical Population and a Cut-off Point to Differentiate Clinical Patients from Healthy Controls. European Eating Disorders Review , 20 (4), 315–320. https://doi.org/10.1002/erv.1144 Lavietes, M., & Ramos, E. (2022, March 20). Nearly 240 anti-LGBTQ bills filed in 2022 so far, most of them targeting trans people . NBC News. https://www.nbcnews.com/nbc-out/out-politics-and-policy/nearly-240-anti-lgbtq-bills-filed-2022-far-targeting-trans-people-rcna20418 Lindley, L., & Galupo, M. P. (2020). Gender dysphoria and minority stress: Support for inclusion of gender dysphoria as a proximal stressor. Psychology of Sexual Orientation and Gender Diversity , 7 (3), 265–275. https://doi.org/10.1037/sgd0000439 Meyer, I. H. (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin , 129 (5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674 Mitchison, D., Hay, P., Slewa-Younan, S., & Mond, J. (2014). The changing demographic profile of eating disorder behaviors in the community. BMC Public Health , 14 (1), 1–9. https://doi.org/10.1186/1471-2458-14-943 Movement Advancement Project. (2025). Equality Maps Snapshot: LGBTQ Equality By State. https://www.lgbtmap.org/equality-maps Mulders-Jones, B., Mitchison, D., Girosi, F., & Hay, P. (2017). Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. PLoS ONE , 12 (1). https://doi.org/10.1371/journal.pone.0170603 Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology , 72 (2), 214–231. https://doi.org/10.1111/j.1365-2265.2009.03625.x Nagata, J. M., Ganson, K. T., & Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities. Current Opinion in Psychiatry , 33 (6), 562–567. https://doi.org/10.1097/YCO.0000000000000645 Nolan, I. T., Kuhner, C. J., & Dy, G. W. (2019). Demographic and temporal trends in transgender identities and gender confirming surgery. Translational Andrology and Urology , 8 (3), 184–190. https://doi.org/10.21037/tau.2019.04.09 Owen-Smith, A. A., Gerth, J., Sineath, R. C., Barzilay, J., Becerra-Culqui, T. A., Getahun, D., Giammattei, S., Hunkeler, E., Lash, T. L., Millman, A., Nash, R., Quinn, V. P., Robinson, B., Roblin, D., Sanchez, T., Silverberg, M. J., Tangpricha, V., Valentine, C., Winter, S., … Goodman, M. (2018). Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals. Journal of Sexual Medicine , 15 (4), 591–600. https://doi.org/10.1016/j.jsxm.2018.01.017 Pulice-Farrow, L., Cusack, C. E., & Galupo, M. P. (2020). “Certain Parts of My Body Don’t Belong to Me”: Trans Individuals’ Descriptions of Body-Specific Gender Dysphoria. Sexuality Research and Social Policy , 17 (4), 654–667. https://doi.org/10.1007/s13178-019-00423-y Restar, A., Jin, H., Breslow, A., Reisner, S. L., Mimiaga, M., Cahill, S., & Hughto, J. M. W. (2020). Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. SSM - Population Health , 11 , 100595. https://doi.org/10.1016/j.ssmph.2020.100595 Romano, K. A., & Lipson, S. K. (2021). Weight misperception and thin-ideal overvaluation relative to the positive functioning and eating disorder pathology of transgender and nonbinary young adults. Psychology of Sexual Orientation and Gender Diversity . https://doi.org/10.1037/sgd0000524 Schaumberg, K., Anderson, L. M., Reilly, E., & Anderson, D. A. (2014). Patterns of Compensatory Behaviors and Disordered Eating in College Students. Journal of American College Health , 62 (8), 526–533. https://doi.org/10.1080/07448481.2014.930468 Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders , 51 (6), 518–526. https://doi.org/10.1002/eat.22846 Sosa, T. (2025). THE SUCCESSFUL DIFFUSION OF GENDER-AFFIRMING CARE BANS IN THE U.S.: HOW PARTISANSHIP FUNCTIONS AS A MECHANISM OF POLICY DIFFUSION . Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the eating disorder diagnostic scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment , 12 (2), 123–131. https://doi.org/10.1037/1040-3590.12.2.123 Striegel Weissman, R., & Rosselli, F. (2017). Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behaviour Research and Therapy , 88 , 49–64. https://doi.org/10.1016/j.brat.2016.09.006 Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the Gender Minority Stress and Resilience Measure. Psychology of Sexual Orientation and Gender Diversity , 2 (1), 65–77. https://doi.org/10.1037/sgd0000081 Testa, R. J., Rider, G. N., Haug, N. A., & Balsam, K. F. (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology , 36 (10), 927–936. https://doi.org/10.1037/hea0000497 Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5–Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biological Psychiatry , 84 (5), 345–354. https://doi.org/10.1016/j.biopsych.2018.03.014 United States v. Skrmetti (2025). https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf van de Grift, T. C., Cohen-Kettenis, P. T., Steensma, T. D., De Cuypere, G., Richter-Appelt, H., Haraldsen, I. R. H., Dikmans, R. E. G., Cerwenka, S. C., & Kreukels, B. P. C. (2016). Body Satisfaction and Physical Appearance in Gender Dysphoria. Archives of Sexual Behavior , 45 (3), 575–585. https://doi.org/10.1007/s10508-015-0614-1 van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2021). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. Transgender Health . https://doi.org/10.1089/trgh.2020.0094 Witcomb, G. L., Bouman, W. P., Brewin, N., Richards, C., Fernandez-Aranda, F., & Arcelus, J. (2015). Body image dissatisfaction and eating-related psychopathology in trans individuals: A matched control study. European Eating Disorders Review , 23 (4), 287–293. https://doi.org/10.1002/ERV.2362 Tables Table 1 – Sample Demographic Profile ( N =60). Total Sample M (SD) or N [%] Age 29.43 (12.30) Income Under $10,000 34 [56.67%] Over $10,000 26 [43.33] Race White 51 [85%] BIPOC Identity 9 [15%] Gender Transfeminine 15 [25.33%] Transmasculine 23 [38.33%] Non-Binary 20 [33.33%] Disordered Eating Composite score 13.53 (11.87) Calorie Restriction Subscale 1.09 (2.60) Eating Disorder Cognitions Subscale 6.95 (4.53) Binge Eating Subscale 5.33 (7.20) Compensatory behaviors (% yes) 31.44% (0.46) Distal and Proximal Stressors Gender Dysphoria 17.62 (9.47) Distal Stress Score 36.25 (14.66) Note . Gender dysphoria was calculated utilizing the Transgender Congruence Scale—Physical Appearance subscale, which was then reverse-coded to reflect gender incongruence (i.e., dysphoria). Table 2: Descriptive Statistics and Correlations Among Variables of Interest ( N =60) 1 2 3 4 5 6 7 8 9 10 11 12 EDDS a - Cog. Dis. b .807*** - - - - - - - - - - - Binge Eating .906*** .552*** - - - - - - - - - - Restriction c .503*** .308* .278* - - - - - - - - - Comp. Behs d .446*** .225 .411*** .229 - - - - - - - - Gender Dysphoria .287* .318* .180 .128 .267* - - - - - - - Distal Stress .102 .136 .068 .011 -.084 .410*** - - - - - - Age -.064 -.032 -.007 -.164 -.108 -.179 -.128 - - - - - BIPOC Identity -.117 .150 -.123 .093 -.017 .061 .063 .069 - - - - Income f -.028 .195 -.064 -.269* -.169 .082 -.173 .013 .009 - - - Transfeminine -.084 .040 -.112 -.153 -.041 .060 .182 .243* -.027 .039 - - Non-Binary -.204 -.305* -.062 -.218 -.101 -.027 -.046 -.206 -.198 .024 -.408*** - Transmasculine .239 .274* .149 .185 .160 .065 -.079 .036 .245 -.067 -.445*** -.558*** Note. * p < .05, ** p < .01, *** p < .001, a Eating Disorder Diagnostic Scale – Disordered Eating; b cognitive distortions, c caloric restriction, d compensatory behaviors, f individuals making over $10,000 a year coded as 1, g BIPOC Identity: Black, Indigenous, and other individuals of color coded as 1. Table 3 – Regression Model Predicting Cognitive Distortions Table 3a. Variable b SE F df p Intercept 5.104 2.336 2.185 50.104 0.034 Gender Dysphoria 0.135 0.062 2.161 50.104 0.035 Distal Stress 0.027 0.041 0.643 50.104 0.523 Transfeminine a -1.888 1.398 -1.350 50.104 0.183 Transmasculine a -4.066 1.261 -3.224 50.104 0.002 Person of Color -3.341 1.518 -2.200 50.104 0.032 Income > $10,000 a Year 1.890 1.095 1.726 50.104 0.090 Age 0.001 0.046 0.013 50.104 0.990 Est. R^2: 0.303, 95% CI [0.119, 0.498] a compared to non-binary individuals. Table 3b. – Regression Model Predicting Cognitive Distortions Variable b SE F df p Intercept 1.841 2.267 0.812 50.104 Gender Dysphoria 0.113 0.063 1.788 50.104 0.080 Distal Stress 0.027 0.041 0.655 50.104 0.515 Transfeminine b 2.100 1.466 1.432 50.104 0.158 Non-binary b 4.087 1.288 3.173 50.104 0.003 Person of Color -3.452 1.532 -2.257 50.104 0.029 Income > $10,000 a Year 1.972 1.100 1.793 50.104 0.079 Age -0.010 0.046 -0.216 50.104 0.830 Est. R^2: 0.299, 95% CI [0.116, 0.495] b compared to transmasculine individuals. Table 4 – Binary Logistic Regression Model Predicting Compensatory Behaviors Table 4a. Variable OR SE t p Intercept 0.291 0.550 0.53 .596 Gender Dysphoria 0.049 0.010 3.13 .002 Distal Stress -0.029 0.352 -2.83 .005 Transfeminine a 0.694 0.352 1.97 .049 Transmasculine a 1.020 0.297 3.43 .001 Person of Color -0.599 0.369 -1.62 .105 Income > $10,000 a Year -0.639 0.258 -2.48 .013 Age -0.041 0.013 -3.26 .001 a compared to non-binary individuals. Table 4b. – Regression Model Predicting Cognitive Distortions Variable OR SE t p Intercept 1.311 0.563 2.33 .020 Gender Dysphoria 0.056 0.016 3.54 <.001 Distal Stress -0.030 0.010 -2.86 .004 Transfeminine a -0.444 0.322 -1.38 .168 Non-binary a -1.455 0.311 -4.67 $10,000 a Year -0.617 0.261 -2.36 .018 Age -0.040 0.013 -3.21 .001 b compared to transmasculine individuals. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Oct, 2025 Read the published version in Sexuality Research and Social Policy → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7093701","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497233080,"identity":"b5d07c20-4d60-4b80-adfe-9623cef1fe69","order_by":0,"name":"Elliott Botelho","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYDACCRBRcICBn4GBDchiJkoLYwODwQEGyQaStQARkVr4pZuPP/hgcEfO+EbyswcMFdaJDYS0SM45ltg4w+CZsdmNNHMDhjPphLUY3MgxbOYxOJy47UaCmQRj22HCWuxBWv4AtWyekf5NgvEfEVoMJIBaGIBaNkjkAG1pIEKLxJ1jiTN7DA4bS5x5U26QcCzdmKAW/tnNBz78qDgsx9+evu3BhxprWYJaUEECacpHwSgYBaNgFOACACIFQy9s2ViBAAAAAElFTkSuQmCC","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":true,"prefix":"","firstName":"Elliott","middleName":"","lastName":"Botelho","suffix":""},{"id":497233081,"identity":"e78d2bd5-9b12-40a5-bc67-c4d1ce8dbbaa","order_by":1,"name":"Alena C. Borgatti","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Alena","middleName":"C.","lastName":"Borgatti","suffix":""},{"id":497233082,"identity":"acbd2b09-9d2f-4c61-9423-a9b772e5f556","order_by":2,"name":"Sierra T. Carrera","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Sierra","middleName":"T.","lastName":"Carrera","suffix":""},{"id":497233083,"identity":"8f55afaf-e5ef-43db-9d09-7ed68abaca5f","order_by":3,"name":"Rory Edwards","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Rory","middleName":"","lastName":"Edwards","suffix":""},{"id":497233084,"identity":"6a957c95-406d-47e3-912c-e9e28d9e44fc","order_by":4,"name":"Nadia S. Spann","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Nadia","middleName":"S.","lastName":"Spann","suffix":""},{"id":497233085,"identity":"af4ebec7-b663-4541-9278-fb795ceba91b","order_by":5,"name":"Caitlin Wolford Clevenger","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Caitlin","middleName":"Wolford","lastName":"Clevenger","suffix":""}],"badges":[],"createdAt":"2025-07-10 13:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7093701/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7093701/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s13178-025-01220-6","type":"published","date":"2025-10-18T15:58:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93956027,"identity":"be853395-ce13-461a-b912-4ab919efd066","added_by":"auto","created_at":"2025-10-20 16:09:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1240683,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7093701/v1/0ff1799f-bbea-439f-85c9-4ae5b32934e3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining Disordered Eating Behaviors Associated with Gender Dysphoria and Minority Stress among Transgender Adults in the Deep South","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAs a minoritized group, transgender individuals face a unique set of stressors related to health disparities, including gender dysphoria, discrimination, and the internalization of society's beliefs and prejudices (Hendricks \u0026amp; Testa, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Lindley \u0026amp; Galupo, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These stressors impact physical and mental health, including disordered eating, which is disproportionately prevalent in transgender populations (Nagata et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Testa et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In one national study of college-aged individuals, 15.8% of transgender people had a diagnosed eating disorder, compared to 1.5% overall (Diemer et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). More recent prevalence estimates suggest that disordered eating, which includes both diagnosable eating disorders as well as subthreshold disordered eating symptoms, were present among roughly 22\u0026ndash;35% of transgender individuals (Romano \u0026amp; Lipson, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Testa et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral unique factors may drive the development of disordered eating in transgender people. Gender dysphoria can relate to appearance or social perception, but often centers around primary and secondary sex characteristics (Galupo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Previous research suggests gender-affirming medical care can successfully alleviate gender dysphoria and improve quality of life; moreover, these interventions predict increased body satisfaction and decreased disordered eating (Testa et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; van Leerdam et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnfortunately, not all individuals are able to pursue transition steps, particularly in the Southeastern United States where gender-affirming care options are under increasing political attack, including a recent total ban on gender affirming care for minors in Tennessee that has been upheld by the U.S. supreme court (Band et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Chin et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sosa, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; \u003cem\u003eUnited States v\u003c/em\u003e. Skrmetti, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Inability to access gender-affirming care may increase the risk of \u0026ldquo;compensatory conditions\u0026rdquo; to mitigate negative body image and body dissatisfaction (Brownstone et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Diemer et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Nolan et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Body image and gender are intertwined for many (i.e., \u0026ldquo;passing,\u0026rdquo; or being perceived in a gender-affirming way by others), and these individuals may engage in disordered eating to feel more affirmed in their bodies, or to exercise control over their bodies and circumstances (Cusack, Iampieri, et al., 2022). Conversely, passing as one\u0026rsquo;s gender may also be protective against disordered eating; for some individuals, feelings of passing increase self-esteem and body satisfaction, which are inversely related to disordered eating (Baranowksi et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Owen-Smith et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Passing may also decrease discrimination and stigma experiences, which can in turn reduce external stress contributing to disordered eating (Diemer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Testa et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGender identity and assigned sex may also impact disordered eating. Being assigned female at birth increases risk for disordered eating, regardless of gender (Witcomb et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). However, findings regarding the role of gender are more unclear, suggesting non-binary individuals may be more frequently diagnosed with an eating disorder, but also have higher rates of body satisfaction (Diemer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Jones et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). One potential explanation for this relationship is that non-binary people experience more stigma and discrimination (especially those who do not \"pass\" as a binary gender), which may increase disordered eating (Diemer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Nagata et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Gender Minority Stress and Resilience\u003c/h2\u003e\u003cp\u003eThe Gender Minority Stress and Resilience Model posits that discrimination and stigma may contribute to health disparities among transgender individuals (Hendricks \u0026amp; Testa, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). This includes distal stressors, or external events that occur when interacting with one\u0026rsquo;s environment, and proximal stressors, which reflect internalized transnegative attitudes and the anticipation of distal stressors. Gender dysphoria is considered a proximal stressor, and has been correlated with anticipated stigma (Lindley \u0026amp; Galupo, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). External stressful events also trigger concerns of the stressor reoccurring (e.g., increased vigilance), and simultaneously contribute to internalized negative societal attitudes; together, these are thought to result in poorer mental health outcomes (Meyer, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section3\"\u003e\u003ch2\u003e1.1.1 Anti-Transgender Policies and the Southeastern United States\u003c/h2\u003e\u003cp\u003eSince 2019, record numbers of anti-transgender policies and legislation have been introduced in the United States, demonstrating the pervasiveness of systemic oppression and marginalization of transgender people (Lavietes \u0026amp; Ramos, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). As of June 2025, the American Civil Liberties Union (ACLU) has monitored a record-breaking 588 anti-transgender bills that have been introduced across the country, with 59 having passed into law (American Civil Liberties Union, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These policies span both the state and federal level, and include a series of Presidential Executive Orders targeting transgender individuals\u0026rsquo; right to access gender-affirming healthcare or obtain federal documentation of citizenship (i.e., passport) with their gender, rather than assigned sex at birth, accurately reflected (Exec. Order No. 14187, 2025; Exec. Order No. 14187, 2025; Exec. Order No. 14201, 2025).\u003c/p\u003e\u003cp\u003eIn addition to this federally-condoned discrimination, transgender individuals experience disproportionate stressors and barriers in the Southeastern United States (frequently referred to as the \u0026ldquo;Deep South\u0026rdquo;), such as discriminatory interpersonal interactions and limited availability of gender-affirming providers (Botelho et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Moreover, nearly all Southeastern states have policies that reduce protections or outright restrict the rights of transgender individuals (Movement Advancement Project, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, this is a limited proxy for how transgender people live in the Deep South, interact with their environment, and how that environment contributes to distal and proximal stress that may exacerbate pre-existing mental health disparities. Despite this ever-growing concern, research on transgender people living in the Deep South is limited.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Present Study\u003c/h2\u003e\u003cp\u003eThe present study is, to our knowledge, the first study to examine disordered eating among transgender people in the Deep South, and the first to examine gender dysphoria and distal stress among transgender individuals in relation to disordered eating. Relationships between gender dysphoria, minority stress, and disordered eating were evaluated, while examining how sociodemographic differences contribute to disordered eating within the transgender community. We hypothesized that greater gender dysphoria and distal minority stress would correlate with increased disordered eating. Further, we explored sociodemographic differences in disordered eating. Finally, ad hoc exploratory analyses for each aim tested whether distal stress and gender dysphoria were related to specific categories of disordered eating symptoms.\u003c/p\u003e\u003c/div\u003e"},{"header":"2. Methods","content":"\u003cp\u003e The Institutional Review Board at MASKEDFORREVIEW approved the present study on May 21, 2019 (protocol #IRB-300002672). Informed consent was obtained electronically via Qualtrics, and participants\u0026rsquo; privacy was maintained throughout the study.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants\u003c/h2\u003e\u003cp\u003eParticipants (\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;60) were recruited via community and campus advertising in two mid-sized Southeastern U.S. cities between 2016\u0026ndash;2018. Individuals were compensated via gift card, and recruited through local gender-affirming providers, university campus advertisements, social media websites, and respondent-driven sampling. Participants were transgender and/or gender non-conforming and \u0026ge;\u0026thinsp;18 years old.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Measures\u003c/h2\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.2.4 Demographic Information\u003c/h2\u003e\u003cp\u003eParticipants provided demographic information, including family income level, race/ethnicity, and age. Income and race/ethnicity were both collected via multiple-choice categorical responses, and dichotomized due to sample size. Gender identity was collected via multiple-choice item, allowing participants to select from a list of options or provide an open response. Due to sample size, these selections were recoded into three categories: transmasculine (including transgender men), non-binary, and transfeminine (including transgender women).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1. Transgender Congruence Scale (TCS) \u0026ndash; Appearance Subscale\u003c/h2\u003e\u003cp\u003eThe TCS is a 15-item Likert-style scale measuring individuals\u0026rsquo; comfort with their gender identity and appearance (Kozee et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Scale items are reverse-scored, with higher scores indicating more gender dysphoria (e.g., gender incongruence). The TCS has previously demonstrated strong construct validity; in the present study, the appearance subscale demonstrated good internal consistency (α\u0026thinsp;=\u0026thinsp;.83).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Eating Disorder Diagnostic Scale (EDDS)\u003c/h2\u003e\u003cp\u003eThe EDDS is a 22-item Likert-style scale which asks individuals about food, weight, and eating-related thoughts within the preceding three months, as well as the weekly frequency of disordered eating behaviors (Stice et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Higher scores suggest greater eating disorder symptomatology. Disordered eating cognitions, caloric restriction, binge eating, and compensatory behaviors (e.g., purging) were also specifically studied. Within the sample, the EDDS composite had good internal consistency (α\u0026thinsp;=\u0026thinsp;.82), while the cognitive distortion and binge eating subscales demonstrated adequate internal consistency (both α\u0026thinsp;=\u0026thinsp;.78). Compensatory behaviors did not present as a unified subscale (α=-.14), with most individuals reporting only one compensatory behavior. As such, compensatory behaviors were operationalized as a singular variable reflecting participants\u0026rsquo; endorsement of any compensatory behavior. Additionally, caloric restriction is a single Likert scale item; as such, measures of internal consistency are not available.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Gender Minority Stress and Resilience Measure \u0026ndash; Distal Stress Subscales\u003c/h2\u003e\u003cp\u003eThe Gender Minority Stress and Resilience Measure contains nine subscales assessing components of gender minority stress and resilience (Testa et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Distal stressors include gender-related discrimination, rejection, victimization, and non-affirmation of gender identity. Previous research summed proximal stressors into a single scale, with confirmatory factor analyses supporting this approach (Lindley \u0026amp; Galupo, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). While evidence supporting a unitary distal stress construct remains unclear, distal stress subscales were summed given the study sample size. This composite showed good internal consistency (α\u0026thinsp;=\u0026thinsp;0.88).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS and RStudio. Missing data were addressed via Random Forest multiple imputation, a method considered appropriate and reliable for psychological research (Golino \u0026amp; Gomes, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegression procedures evaluated relationships between gender dysphoria, distal minority stress, and disordered eating. Bivariate correlations assessed for multicollinearity of gender dysphoria and distal stress subscales to ensure both could be included in a single model. Gender dysphoria and minority stress served as independent variables, with disordered eating scores as the dependent variable. Analyses controlled for age, income, and race, utilizing a Bonferroni correction to protect against Type I error. Due to sample size, omnibus and individual effects were assessed for each of the tested models.\u003c/p\u003e\u003cp\u003eAdditionally, as disordered eating behaviors vary across different diagnoses, a series of ad hoc regressions tested these same variables in relation to disordered eating subscales. Linear regressions assessed caloric restriction, binge eating, and disordered eating cognition subscales; however, as compensatory behaviors were binarized by the presence or absence of symptoms, a logistic regression was used to assess whether symptoms were associated with increased odds of compensatory behavior engagement. A power analysis indicated the study was adequately powered, needing 52 participants to achieve .8 power.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Study Sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were predominantly white (85%) and most earned under $10,000 annually (57%). See Table 1 for complete sample demographics and Table 2 for inter-variable correlations. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Disordered Eating\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e35% (\u003cem\u003en\u003c/em\u003e=21) of participants scored at or above the cutoff score (Krabbenborg et al., 2012) for an eating disorder. Further, 28% of participants reported clinically significant levels of disordered eating cognitions, 15% endorsed compensatory behaviors, 40% reported weekly binge eating, and 27% skipped multiple consecutive meals to influence their weight. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Disordered Eating, Gender Dysphoria, and Distal Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGender dysphoria and distal stress were correlated, but not multicollinear, in bivariate correlations (r(59)=0.420, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). When controlling for age, race, and income, the omnibus \u003cem\u003eF\u003c/em\u003e test of the overall model assessing disordered eating was not significant, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=.10, \u003cem\u003eF\u003c/em\u003e(5,52.11)=1.249, \u003cem\u003ep=\u003c/em\u003e0.30. Two ad hoc sensitivity analyses were performed, one evaluating the inclusion of gender, and the other without demographic covariates; these did not alter significance. At the individual results level and across all three models, a significant positive association emerged between gender dysphoria and disordered eating (\u003cem\u003ep \u003c/em\u003e\u0026lt; .044 for all tested models). Distal stress, age, race, and income were not significantly associated with disordered eating (all \u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.3.1 Exploratory Subscale Analyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA series of exploratory, ad hoc regressions examined associations between gender dysphoria, distal minority stress, and demographic factors on four disordered eating subscales: disordered eating cognitions, binge eating, compensatory behaviors, and caloric restriction. Individuals with greater gender dysphoria, who were transmasculine (as opposed to non-binary), and were white had greater disordered eating cognitions (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=.30, \u003cem\u003eF\u003c/em\u003e(7,50.109)=3.23, \u003cem\u003ep=\u003c/em\u003e0.007; Table 3). The odds of endorsing compensatory behaviors were increased for individuals who were white, younger, and reported greater gender dysphoria, less distal stress, and lower income (\u003cem\u003eF\u003c/em\u003e(6,50.12)=5.94, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001; Table 4). Moreover, gender was associated with compensatory behaviors, wherein transmasculine individuals were more likely to report compensatory behaviors than non-binary or transfeminine individuals, but transfeminine and non-binary individuals did not differ in their likelihood of engaging in compensatory behaviors.\u003c/p\u003e\n\u003cp\u003eThe omnibus \u003cem\u003eF\u003c/em\u003e test examining the relationship between caloric restriction and the variables of interest was not significant, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=.17, \u003cem\u003eF\u003c/em\u003e(7,44.05)=1.114, \u003cem\u003ep=\u003c/em\u003e0.37. However, lower income was related to increased caloric restriction (\u003cem\u003eb\u003c/em\u003e=-1.52, \u003cem\u003ep\u003c/em\u003e=.04). Binge eating was not associated with any variables of interest, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=.09, \u003cem\u003eF\u003c/em\u003e(7,50.11)=.75, \u003cem\u003ep=\u003c/em\u003e0.64.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe present study explored associations between minority stress, gender dysphoria, and disordered eating in two mid-to-large cities in the Deep South. It also compared disordered eating across age, income, race/ethnicity, and gender. To date, few studies have evaluated these factors in the context of the Gender Minority Stress and Resilience Theory, especially among residents of the Deep South (Hendricks \u0026amp; Testa, 2012).\u003c/p\u003e\n\u003cp\u003eDisordered eating behaviors were present in a large proportion (35%) of the sample, consistent or slightly elevated compared to prior studies (22-35%; Romano \u0026amp; Lipson, 2021; Testa et al., 2017). While direct sample comparisons were not available and sample size precludes determining whether this constitutes a meaningful difference, certain regional and sample differences may relate to this variability in prevalence. This may include systemic and intersectional contributors to discrimination and poor health, such as anti-transgender legislation efforts, stricter societal norms around gender contributing to increased dysphoria, limited access to gender affirming care and mental healthcare within the region or due to income, food insecurity, and instability secondary to low income. \u0026nbsp;Nearly 60% of the current sample had an annual income under $10,000, further highlighting the pervasive systemic inequities within the region and the unique burden experienced by this group relative to many other research samples in the broader disordered eating literature (Halbeisen et al., 2022). To our knowledge, this is the first study to examine disordered eating among transgender people in the Deep South, a population subjected to high levels of gender minority stressors at interpersonal and systemic levels (Botelho et al., 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Disordered Eating Symptom Correlates: Composite Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe hypothesis that disordered eating would correlate with gender dysphoria and distal stress was partially supported; on the composite measure, disordered eating was associated with gender dysphoria, although distal stress was not. There are a number of possible explanations for this finding. First, it is possible that individuals experiencing gender dysphoria may engage in disordered eating to help manage dysphoria, whereas distal stressors do not prompt this same response. It is also possible that distal stressors may be ever-present for transgender individuals, precipitating gender dysphoria, but not the internalization of transnegativity or translation into disordered eating. Alternatively, since disordered eating is often conceptualized as a set of internalizing behaviors (Forbush et al., 2017), there may be an underlying propensity for internalization that contributes to both gender dysphoria and disordered eating (Brewster et al., 2019). It is also possible that the present model does not account for modifying factors, such as pride in one\u0026rsquo;s identity (Hendricks \u0026amp; Testa, 2012; Testa et al., 2015), which may reduce the impact of factors that result in poorer outcomes (i.e., disordered eating).\u003c/p\u003e\n\u003cp\u003eComposite disordered eating did not differ across income, race, or age, a significant departure from previous research (Mitchison et al., 2014; Mulders-Jones et al., 2017; Sonneville \u0026amp; Lipson, 2018; Stice et al., 2000; Testa et al., 2017; Udo \u0026amp; Grilo, 2018; Witcomb et al., 2015) . This deviation from prior findings may be related to the study\u0026rsquo;s smaller sample, participants\u0026rsquo; socioeconomic status (i.e., 57% with under $10,000 annual income), and overrepresentation of white participants. \u003cstrong\u003e4.2 Disordered Eating Symptom Clusters\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4.2.1\u003c/em\u003e\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003eCorrelates of Cognitive Distortions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDisordered eating cognitions correlated with gender dysphoria, being white, and being transmasculine. As data were collected cross-sectionally, the exact process through which disordered eating and gender dysphoria are related is unknown. \u0026nbsp;For example, individuals may focus on body shape or weight as a gendered experience, thus impacting how they view their size; alternatively, increased disordered eating cognitions may lead to more body consciousness, thereby increasing gender dysphoria. This is in line with prior qualitative studies which suggest that for many individuals, body image and gender are deeply intertwined (Pulice-Farrow et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, transmasculine individuals endorsed more disordered eating cognitions than non-binary individuals, but not transfeminine individuals; notably, prior findings suggest that individuals assigned female at birth exhibit higher rates of disordered eating than their counterparts, accounting for their gender (Witcomb et al., 2015). While some prior studies suggest that non-binary individuals have more body satisfaction and less disordered eating, other studies suggest the stigma of gender nonconformity could increase risk of disordered eating (Diemer et al., 2018; Jones et al., 2019). Previous research suggests that non-binary people do not feel that established, assigned sex-specific gender dysphoria measurement scales accurately capture their experiences(Galupo \u0026amp; Pulice-Farrow, 2020). Thus, perhaps the experiences of non-binary people are qualitatively different from binary transgender individuals, and this difference may buffer against disordered eating cognitions. The present study utilized the TCS, a broad measure of gender congruence, to quantify gender dysphoria as opposed to an assigned sex-specific measure; this is a strength of the present study and likely reduced measurement error between binary and non-binary individuals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4.2.2 Correlates of Compensatory Behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompensatory behaviors positively correlated with gender dysphoria, consistent with previous literature (Diemer et al., 2015; Kozee et al., 2012; van de Grift et al., 2016). Interestingly, distal stress was negatively associated with compensatory behaviors. This effect was lessened in bivariate correlations, suggesting that other factors (e.g., age, race, income, or gender dysphoria) may influence distal stress and compensatory behaviors. This is further supported by the significant associations between compensatory behaviors and other variables within the model (i.e., income, gender). Perhaps individuals have separate regulation mechanisms for experiences of discrimination, violence, and non-affirmation, or unassessed latent variables moderate this relationship, such as emotion regulation, gender minority resilience, or trait internalizing (Brewster et al., 2019; King et al., 2020). As resilience may buffer against adverse physical and mental health outcomes (Hendricks \u0026amp; Testa, 2012), future studies should examine whether resilience might potentially reverse associations between distal stress and compensatory behaviors, a finding supported by prior literature demonstrating negative corollary relationships between distal stressors and resilience factors (Breslow et al., 2015).\u003c/p\u003e\n\u003cp\u003eGiven the negative Cronbach\u0026rsquo;s\u0026nbsp;𝛼,\u0026nbsp;the compensatory behavior model used a categorical outcome variable indicating whether participants had endorsed any compensatory behaviors. Similarly, future research may consider creating a singular variable representative of any endorsement of compensatory behavior, since individuals with purging behaviors often endorse a singular method of choice (rather than multiple; Haedt et al., 2006; Schaumberg et al., 2014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4.2.3 Correlates of Caloric Restriction\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the overall model was non-significant, caloric restriction was significantly associated with lower yearly income, consistent with previous literature (Testa et al., 2017). This could be related to food insecurity, continuing stressors of living in severe poverty, or a way to manage gender dysphoria when affordable gender-affirming healthcare is otherwise unavailable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Implications for Clinical Practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights the high prevalence of disordered eating among transgender individuals, reinforces the need for further research into disordered eating among the transgender community, and emphasizes the importance of policies that may mitigate gender dysphoria, including gender affirming healthcare. Although the sample is smaller, the high prevalence of disordered eating is alarming and reinforces the need for tailored disordered eating screening and prevention efforts for those experiencing gender dysphoria. Additional studies of transgender individuals in the Deep South are important to explore how the regional environment may impact health; qualitative work could be especially helpful for identifying relevant risk factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe high prevalence of disordered eating within the sample highlights a need for screening and intervention. Clinicians should consider how gender dysphoria and disordered eating cognitions interact when working with clients, particularly transmasculine individuals. For transgender clients who have undergone eating disorder treatment, processing gender dysphoria and unpacking gender role socialization expectations have been reported as beneficial aspects of treatment (Cusack, Levenson, et al., 2022). However, infusing stereotypes about transgender individuals into eating disorder treatment (e.g., eating disorders develop \u003cem\u003ebecause\u003c/em\u003e a person is transgender) were considered unhelpful (Cusack, Levenson, et al., 2022). Given the limited study of disordered eating among transgender individuals, as well as variable mechanisms through which gender dysphoria may impact disordered eating, clinicians should avoid introducing reductionist etiological stereotypes into treatment (e.g., that gender dysphoria is the sole cause of a client\u0026rsquo;s disordered eating). Clinicians must also remember that they often serve as gatekeepers to accessing gender-affirming care when such care is available, and prioritizing a single narrative of transitioning may perpetuate the transnormative binary medical model (and possibly, by extension, disordered eating) in healthcare systems while also reducing access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4. Policy Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGender dysphoria was associated with disordered eating within the current sample, and past research has demonstrated that gender-affirming care improves quality of life, decreases gender dysphoria, and decreases disordered eating (Murad et al., 2010; Testa et al., 2017). In recent years, there has been a dramatic and pervasive increase in anti-transgender legislation and policy, which has created a hostile sociopolitical climate for transgender individuals (Lavietes \u0026amp; Ramos, 2022). These policies have only increased in 2025, including a series of Presidential Executive Orders targeted at defining sex and gender as binary and equal, rather than a spectrum or a state that may change over time (Exec. Order No. 14187, 2025). While these policy guidelines affect all transgender people, they have a unique effect on non-binary individuals, who may not wish to pass as or conform to one binary gender. Policymakers and advocates must seek to enshrine into legislation the difference between sex and gender, as well as recognizing the existence of non-binary genders. Moreover, policy that protects the transgender community\u0026rsquo;s right to accurate and updated social and legal identification throughout the United States, at both the state and federal levels, may reduce gender dysphoria and improve mental health (Restar et al., 2020).\u003c/p\u003e\n\u003cp\u003eConcerningly, the Trump Administration\u0026rsquo;s Executive Order #14187 (Exec. Order No. 14187, 2025) specifically discredits the World Professional Association of Transgender Health\u0026rsquo;s Standards of Care (WPATH SOC), which are widely regarded as best practices for working with transgender individuals in healthcare settings and reflect findings of over 1,500 peer-reviewed manuscripts and studies (Coleman et al., 2022). Given the relationship between disordered eating and gender dysphoria, eating disorder professionals specifically should be called on to reaffirm these gold standard and evidence-based guidelines and reject efforts to binarize gender or restrict gender affirming care, as this federal guidance may increase gender dysphoria and disordered eating, adding strain to a healthcare sector that is already severely challenged by unmet treatment needs (Striegel Weissman \u0026amp; Rosselli, 2017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5 Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study has several key limitations. Participants were predominantly white, and only sampled from two Southern states, without the ability to control for urbanicity or rurality within analyses. Additionally, information and strength of relationships on sociodemographic differences should be interpreted with caution, given that most individuals reported a family income well below established poverty levels. Thus, true differences may be obscured by the homogeneity of the present sample.\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eIn addition, moderate quantities of missing data (44.8% cases with any missing data, 17.7% missing data points), combined with the small sample size, necessitated imputation procedures before data analysis. Thus, limitations to generalizability should be strongly considered in the context of these sample parameters. Furthermore, the sample size precluded the examination of interactions between assigned sex at birth and gender, and limited our ability to examine the association between income and other variables of interest in a trichotomous format. As such, effects related to assigned sex or income may have been masked within the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.6 Conclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransgender individuals experience more health challenges than their cisgender counterparts, including increased risk of experiencing disordered eating. The current study revealed a high rate of disordered eating within a sample of transgender adults within the Deep South, as well as associations between disordered eating and gender dysphoria, distal stress, gender, race, and income. Identifying unique factors associated with the development of disordered eating within this population not only adds to the literature regarding these topics, but may also have critical clinical and policy implications for transgender adults living within the Deep South\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work was supported, in part, by the Malyon-Smith Scholarship Award sponsored by Division 44 of the American Psychological Association (APA), grant F31AA024685 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Thomas Fellowship awarded to the last author. The first author is supported by grant T32HS013852 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of APA Division 44, the NIAAA, the NIDDK, National Institutes of Health, the Thomas family, or the Agency of Healthcare Research and Quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e Due to the small sample size of this data and risk of participant identification via the data, the data utilized in the present study are not publicly available. Questions regarding the data or its use should be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability:\u003c/strong\u003e Not Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We would like to thank Gregory L. Stuart for his guidance in acquiring funding for the parent study, Drs. Leticia Flores and Rebecca Morgan for recruitment assistance, and Drs. Andres Azuero and Edwin W. Cook III for their guidance in statistical methodology.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to study conceptualization. E.B. completed study conceptualization, methodology, formal analysis, and original draft writing. CWC completed study conceptualization, funding acquisition, investigation, writing \u0026ndash; review and editing, supervision. A.B. completed revisions to writing and preparation for submissions. R.E., S.T.C, and N.S.S. were involved in data curation and revising manuscript drafts.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAmerican Civil Liberties Union. (2025). \u003cem\u003eLegislative Attacks on LGBTQ Rights\u0026mdash;2025\u003c/em\u003e. American Civil Liberties Union. https://www.aclu.org/legislative-attacks-on-lgbtq-rights-2025\u003c/li\u003e\n \u003cli\u003eBand, I. C., Dubois, B., Ghofranian, A., Nietsch, K. S., Lee, J. A., Friedenthal, J., Copperman, A. B., \u0026amp; Estevez, S. L. (2025). An Analysis of Gender-Affirming Care Offerings on United States Pediatric Hospital Websites: Exploring the Impact of State Legislative Bans. \u003cem\u003eLGBT Health\u003c/em\u003e, lgbt.2024.0214. https://doi.org/10.1089/lgbt.2024.0214\u003c/li\u003e\n \u003cli\u003eBaranowksi, M. J., Jorga, J., Djordjevic, I., Marinkovic, J., \u0026amp; Hetherington, M. M. (2003). Evaluation of adolescent body satisfaction and associated eating disorder pathology in two communities. \u003cem\u003eEuropean Eating Disorders Review\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(6), 478\u0026ndash;495. https://doi.org/10.1002/ERV.529\u003c/li\u003e\n \u003cli\u003eBotelho, E., Goldbach, C., Johnson, A. H., \u0026amp; Crockett, K. B. (2024). \u0026ldquo;[Being] Trans Is So Much More Than Medical Models\u0026rdquo;: A Qualitative Examination of Transgender Adults\u0026rsquo; Healthcare Experiences in the Southeastern United States. \u003cem\u003eAnnals of LGBTQ Public and Population Health\u003c/em\u003e, LGBTQ-2023-0041.R1. https://doi.org/10.1891/LGBTQ-2023-0041\u003c/li\u003e\n \u003cli\u003eBreslow, A. S., Brewster, M. E., Velez, B. L., Wong, S., Geiger, E., \u0026amp; Soderstrom, B. (2015). Resilience and Collective Action: Exploring Buffers Against Minority Stress for Transgender Individuals. \u003cem\u003ePsychology of Sexual Orientation and Gender Diversity\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(3), 253\u0026ndash;265. https://doi.org/10.1037/sgd0000117\u003c/li\u003e\n \u003cli\u003eBrewster, M. E., Velez, B. L., Breslow, A. S., \u0026amp; Geiger, E. F. (2019). Unpacking body image concerns and disordered eating for transgender women: The roles of sexual objectification and minority stress. \u003cem\u003eJournal of Counseling Psychology\u003c/em\u003e, \u003cem\u003e66\u003c/em\u003e(2), 131\u0026ndash;142. https://doi.org/10.1037/cou0000333\u003c/li\u003e\n \u003cli\u003eBrownstone, L. M., Kelly, D. A., Maloul, E. K., Dinneen, J. L., Palazzolo, L. A., Raque, T. L., \u0026amp; Greene, A. K. (2021). \u0026ldquo;It\u0026rsquo;s just not comfortable to exist in a body\u0026rdquo;: Transgender/gender nonbinary individuals\u0026rsquo; experiences of body and eating distress during the COVID-19 pandemic. \u003cem\u003ePsychology of Sexual Orientation and Gender Diversity\u003c/em\u003e. https://doi.org/10.1037/sgd0000519\u003c/li\u003e\n \u003cli\u003eChin, M. G., LaGuardia, J. S., Morgan, K. B. J., Ngo, H., Moghadam, S., Huang, K. X., Bedar, M., Cronin, B. J., Kwan, D., \u0026amp; Lee, J. C. (2024). United States Health Policies on Gender-Affirming Care in 2022. \u003cem\u003ePlastic \u0026amp; Reconstructive Surgery\u003c/em\u003e, \u003cem\u003e153\u003c/em\u003e(2), 462e\u0026ndash;473e. https://doi.org/10.1097/PRS.0000000000010594\u003c/li\u003e\n \u003cli\u003eColeman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., \u0026hellip; Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. \u003cem\u003eInternational Journal of Transgender Health\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(sup1), S1\u0026ndash;S259. https://doi.org/10.1080/26895269.2022.2100644\u003c/li\u003e\n \u003cli\u003eCusack, C. E., Iampieri, A. O., \u0026amp; Galupo, M. P. (2022). \u0026ldquo;I\u0026rsquo;m still not sure if the eating disorder is a result of gender dysphoria\u0026rdquo;: Trans and nonbinary individuals\u0026rsquo; descriptions of their eating and body concerns in relation to their gender. \u003cem\u003ePsychology of Sexual Orientation and Gender Diversity\u003c/em\u003e. https://doi.org/10.1037/sgd0000515\u003c/li\u003e\n \u003cli\u003eCusack, C. E., Levenson, N. H., \u0026amp; Galupo, M. P. (2022). \u0026ldquo;Anorexia Wants to Kill Me, Dysphoria Wants Me to Live\u0026rdquo;: Centering Transgender and Nonbinary Experiences in Eating Disorder Treatment. \u003cem\u003eJournal of LGBTQ Issues in Counseling\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(3), 265\u0026ndash;284. https://doi.org/10.1080/26924951.2022.2054492\u003c/li\u003e\n \u003cli\u003eDiemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., \u0026amp; Duncan, A. E. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. \u003cem\u003eJournal of Adolescent Health\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(2), 144\u0026ndash;149. https://doi.org/10.1016/j.jadohealth.2015.03.003\u003c/li\u003e\n \u003cli\u003eDiemer, E. W., Hughto, J. M. W., Gordon, A. R., Guss, C., Austin, S. B., \u0026amp; Reisner, S. L. (2018). Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. \u003cem\u003eTransgender Health\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 17. https://doi.org/10.1089/TRGH.2017.0043\u003c/li\u003e\n \u003cli\u003eExec. Order No. 14187, 3 C.F.R. (2025).\u003c/li\u003e\n \u003cli\u003eExec. Order No. 14201, Executive Order, 3 C.F.R. (2025).\u003c/li\u003e\n \u003cli\u003eForbush, K. T., Hagan, K. E., Kite, B. A., Chapa, D. A. N., Bohrer, B. K., \u0026amp; Gould, S. R. (2017). Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. \u003cem\u003eComprehensive Psychiatry\u003c/em\u003e, \u003cem\u003e79\u003c/em\u003e, 40\u0026ndash;52. https://doi.org/10.1016/j.comppsych.2017.06.009\u003c/li\u003e\n \u003cli\u003eGalupo, M. P., \u0026amp; Pulice-Farrow, L. (2020). Subjective Ratings of Gender Dysphoria Scales by Transgender Individuals. \u003cem\u003eArchives of Sexual Behavior\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(2), 479\u0026ndash;488. https://doi.org/10.1007/s10508-019-01556-2\u003c/li\u003e\n \u003cli\u003eGalupo, M. P., Pulice-Farrow, L., \u0026amp; Lindley, L. (2020). \u0026ldquo;Every time I get gendered male, I feel a pain in my chest\u0026rdquo;: Understanding the social context for gender dysphoria. \u003cem\u003eStigma and Health\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(2), 199\u0026ndash;208. https://doi.org/10.1037/sah0000189\u003c/li\u003e\n \u003cli\u003eGolino, H. F., \u0026amp; Gomes, C. M. A. (2016). Random forest as an imputation method for education and psychology research: Its impact on item fit and difficulty of the Rasch model. \u003cem\u003eInternational Journal of Research \u0026amp; Method in Education\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(4), 401\u0026ndash;421. https://doi.org/10.1080/1743727X.2016.1168798\u003c/li\u003e\n \u003cli\u003eHaedt, A. A., Edler, C., Heatherton, T. F., \u0026amp; Keel, P. K. (2006). Importance of multiple purging methods in the classification of eating disorder subtypes. \u003cem\u003eInternational Journal of Eating Disorders\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(8), 648\u0026ndash;654. https://doi.org/10.1002/eat.20335\u003c/li\u003e\n \u003cli\u003eHalbeisen, G., Brandt, G., \u0026amp; Paslakis, G. (2022). A Plea for Diversity in Eating Disorders Research. \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 820043. https://doi.org/10.3389/fpsyt.2022.820043\u003c/li\u003e\n \u003cli\u003eHendricks, M. L., \u0026amp; Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. \u003cem\u003eProfessional Psychology: Research and Practice\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(5), 460\u0026ndash;467. https://doi.org/10.1037/a0029597\u003c/li\u003e\n \u003cli\u003eJones, B. A., Pierre Bouman, W., Haycraft, E., \u0026amp; Arcelus, J. (2019). Gender congruence and body satisfaction in nonbinary transgender people: A case control study. \u003cem\u003eInternational Journal of Transgenderism\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(2\u0026ndash;3), 263\u0026ndash;274. https://doi.org/10.1080/15532739.2018.1538840\u003c/li\u003e\n \u003cli\u003eKing, K. M., Feil, M. C., Halvorson, M. A., Kosterman, R., Bailey, J. A., \u0026amp; Hawkins, J. D. (2020). A trait-like propensity to experience internalizing symptoms is associated with problem alcohol involvement across adulthood, but not adolescence. \u003cem\u003ePsychology of Addictive Behaviors\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(7), 756\u0026ndash;771. https://doi.org/10.1037/adb0000589\u003c/li\u003e\n \u003cli\u003eKozee, H. B., Tylka, T. L., \u0026amp; Bauerband, L. A. (2012). Measuring Transgender Individuals\u0026rsquo; Comfort With Gender Identity and Appearance: Development and Validation of the Transgender Congruence Scale. \u003cem\u003ePsychology of Women Quarterly\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e(2), 179\u0026ndash;196. https://doi.org/10.1177/0361684312442161\u003c/li\u003e\n \u003cli\u003eKrabbenborg, M. A. M., Danner, U. N., Larsen, J. K., van der Veer, N., van Elburg, A. A., de Ridder, D. T. D., Evers, C., Stice, E., \u0026amp; Engels, R. C. M. E. (2012). The Eating Disorder Diagnostic Scale: Psychometric Features Within a Clinical Population and a Cut-off Point to Differentiate Clinical Patients from Healthy Controls. \u003cem\u003eEuropean Eating Disorders Review\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(4), 315\u0026ndash;320. https://doi.org/10.1002/erv.1144\u003c/li\u003e\n \u003cli\u003eLavietes, M., \u0026amp; Ramos, E. (2022, March 20). \u003cem\u003eNearly 240 anti-LGBTQ bills filed in 2022 so far, most of them targeting trans people\u003c/em\u003e. NBC News. https://www.nbcnews.com/nbc-out/out-politics-and-policy/nearly-240-anti-lgbtq-bills-filed-2022-far-targeting-trans-people-rcna20418\u003c/li\u003e\n \u003cli\u003eLindley, L., \u0026amp; Galupo, M. P. (2020). Gender dysphoria and minority stress: Support for inclusion of gender dysphoria as a proximal stressor. \u003cem\u003ePsychology of Sexual Orientation and Gender Diversity\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(3), 265\u0026ndash;275. https://doi.org/10.1037/sgd0000439\u003c/li\u003e\n \u003cli\u003eMeyer, I. H. (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. \u003cem\u003ePsychological Bulletin\u003c/em\u003e, \u003cem\u003e129\u003c/em\u003e(5), 674\u0026ndash;697. https://doi.org/10.1037/0033-2909.129.5.674\u003c/li\u003e\n \u003cli\u003eMitchison, D., Hay, P., Slewa-Younan, S., \u0026amp; Mond, J. (2014). The changing demographic profile of eating disorder behaviors in the community. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(1), 1\u0026ndash;9. https://doi.org/10.1186/1471-2458-14-943\u003c/li\u003e\n \u003cli\u003eMovement Advancement Project. (2025). \u003cem\u003eEquality Maps Snapshot: LGBTQ Equality By State.\u003c/em\u003e https://www.lgbtmap.org/equality-maps\u003c/li\u003e\n \u003cli\u003eMulders-Jones, B., Mitchison, D., Girosi, F., \u0026amp; Hay, P. (2017). Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. \u003cem\u003ePLoS ONE\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1). https://doi.org/10.1371/journal.pone.0170603\u003c/li\u003e\n \u003cli\u003eMurad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., \u0026amp; Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. \u003cem\u003eClinical Endocrinology\u003c/em\u003e, \u003cem\u003e72\u003c/em\u003e(2), 214\u0026ndash;231. https://doi.org/10.1111/j.1365-2265.2009.03625.x\u003c/li\u003e\n \u003cli\u003eNagata, J. M., Ganson, K. T., \u0026amp; Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities. \u003cem\u003eCurrent Opinion in Psychiatry\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(6), 562\u0026ndash;567. https://doi.org/10.1097/YCO.0000000000000645\u003c/li\u003e\n \u003cli\u003eNolan, I. T., Kuhner, C. J., \u0026amp; Dy, G. W. (2019). Demographic and temporal trends in transgender identities and gender confirming surgery. \u003cem\u003eTranslational Andrology and Urology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(3), 184\u0026ndash;190. https://doi.org/10.21037/tau.2019.04.09\u003c/li\u003e\n \u003cli\u003eOwen-Smith, A. A., Gerth, J., Sineath, R. C., Barzilay, J., Becerra-Culqui, T. A., Getahun, D., Giammattei, S., Hunkeler, E., Lash, T. L., Millman, A., Nash, R., Quinn, V. P., Robinson, B., Roblin, D., Sanchez, T., Silverberg, M. J., Tangpricha, V., Valentine, C., Winter, S., \u0026hellip; Goodman, M. (2018). Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals. \u003cem\u003eJournal of Sexual Medicine\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(4), 591\u0026ndash;600. https://doi.org/10.1016/j.jsxm.2018.01.017\u003c/li\u003e\n \u003cli\u003ePulice-Farrow, L., Cusack, C. E., \u0026amp; Galupo, M. P. (2020). \u0026ldquo;Certain Parts of My Body Don\u0026rsquo;t Belong to Me\u0026rdquo;: Trans Individuals\u0026rsquo; Descriptions of Body-Specific Gender Dysphoria. \u003cem\u003eSexuality Research and Social Policy\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(4), 654\u0026ndash;667. https://doi.org/10.1007/s13178-019-00423-y\u003c/li\u003e\n \u003cli\u003eRestar, A., Jin, H., Breslow, A., Reisner, S. L., Mimiaga, M., Cahill, S., \u0026amp; Hughto, J. M. W. (2020). Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. \u003cem\u003eSSM - Population Health\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 100595. https://doi.org/10.1016/j.ssmph.2020.100595\u003c/li\u003e\n \u003cli\u003eRomano, K. A., \u0026amp; Lipson, S. K. (2021). Weight misperception and thin-ideal overvaluation relative to the positive functioning and eating disorder pathology of transgender and nonbinary young adults. \u003cem\u003ePsychology of Sexual Orientation and Gender Diversity\u003c/em\u003e. https://doi.org/10.1037/sgd0000524\u003c/li\u003e\n \u003cli\u003eSchaumberg, K., Anderson, L. M., Reilly, E., \u0026amp; Anderson, D. A. (2014). Patterns of Compensatory Behaviors and Disordered Eating in College Students. \u003cem\u003eJournal of American College Health\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(8), 526\u0026ndash;533. https://doi.org/10.1080/07448481.2014.930468\u003c/li\u003e\n \u003cli\u003eSonneville, K. R., \u0026amp; Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. \u003cem\u003eInternational Journal of Eating Disorders\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(6), 518\u0026ndash;526. https://doi.org/10.1002/eat.22846\u003c/li\u003e\n \u003cli\u003eSosa, T. (2025). \u003cem\u003eTHE SUCCESSFUL DIFFUSION OF GENDER-AFFIRMING CARE BANS IN THE U.S.: HOW PARTISANSHIP FUNCTIONS AS A MECHANISM OF POLICY DIFFUSION\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eStice, E., Telch, C. F., \u0026amp; Rizvi, S. L. (2000). Development and validation of the eating disorder diagnostic scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. \u003cem\u003ePsychological Assessment\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(2), 123\u0026ndash;131. https://doi.org/10.1037/1040-3590.12.2.123\u003c/li\u003e\n \u003cli\u003eStriegel Weissman, R., \u0026amp; Rosselli, F. (2017). Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. \u003cem\u003eBehaviour Research and Therapy\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e, 49\u0026ndash;64. https://doi.org/10.1016/j.brat.2016.09.006\u003c/li\u003e\n \u003cli\u003eTesta, R. J., Habarth, J., Peta, J., Balsam, K., \u0026amp; Bockting, W. (2015). Development of the Gender Minority Stress and Resilience Measure. \u003cem\u003ePsychology of Sexual Orientation and Gender Diversity\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(1), 65\u0026ndash;77. https://doi.org/10.1037/sgd0000081\u003c/li\u003e\n \u003cli\u003eTesta, R. J., Rider, G. N., Haug, N. A., \u0026amp; Balsam, K. F. (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. \u003cem\u003eHealth Psychology\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e(10), 927\u0026ndash;936. https://doi.org/10.1037/hea0000497\u003c/li\u003e\n \u003cli\u003eUdo, T., \u0026amp; Grilo, C. M. (2018). Prevalence and Correlates of DSM-5\u0026ndash;Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. \u003cem\u003eBiological Psychiatry\u003c/em\u003e, \u003cem\u003e84\u003c/em\u003e(5), 345\u0026ndash;354. https://doi.org/10.1016/j.biopsych.2018.03.014\u003c/li\u003e\n \u003cli\u003eUnited States v. Skrmetti (2025). https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf\u003c/li\u003e\n \u003cli\u003evan de Grift, T. C., Cohen-Kettenis, P. T., Steensma, T. D., De Cuypere, G., Richter-Appelt, H., Haraldsen, I. R. H., Dikmans, R. E. G., Cerwenka, S. C., \u0026amp; Kreukels, B. P. C. (2016). Body Satisfaction and Physical Appearance in Gender Dysphoria. \u003cem\u003eArchives of Sexual Behavior\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(3), 575\u0026ndash;585. https://doi.org/10.1007/s10508-015-0614-1\u003c/li\u003e\n \u003cli\u003evan Leerdam, T. R., Zajac, J. D., \u0026amp; Cheung, A. S. (2021). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. \u003cem\u003eTransgender Health\u003c/em\u003e. https://doi.org/10.1089/trgh.2020.0094\u003c/li\u003e\n \u003cli\u003eWitcomb, G. L., Bouman, W. P., Brewin, N., Richards, C., Fernandez-Aranda, F., \u0026amp; Arcelus, J. (2015). Body image dissatisfaction and eating-related psychopathology in trans individuals: A matched control study. \u003cem\u003eEuropean Eating Disorders Review\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(4), 287\u0026ndash;293. https://doi.org/10.1002/ERV.2362\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u0026ndash; Sample Demographic Profile (\u003cem\u003eN\u003c/em\u003e=60).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"437\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal Sample\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM (SD) or N [%]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e29.43 (12.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eUnder $10,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e34 [56.67%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eOver $10,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e26 [43.33]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e51 [85%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eBIPOC Identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e9 [15%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eTransfeminine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e15 [25.33%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eTransmasculine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e23 [38.33%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eNon-Binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e20 [33.33%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003eDisordered Eating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eComposite score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e13.53 (11.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eCalorie Restriction Subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1.09 (2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eEating Disorder Cognitions Subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e6.95 (4.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eBinge Eating Subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e5.33 (7.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eCompensatory behaviors (% yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e31.44% (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 317px;\"\u003e\n \u003cp\u003eDistal and Proximal Stressors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eGender Dysphoria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e17.62 (9.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eDistal Stress Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e36.25 (14.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 437px;\"\u003e\n \u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. Gender dysphoria was calculated utilizing the Transgender Congruence Scale\u0026mdash;Physical Appearance subscale, which was then reverse-coded to reflect gender incongruence (i.e., dysphoria).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eDescriptive Statistics and Correlations Among Variables of Interest\u003cem\u003e\u0026nbsp;\u003c/em\u003e(\u003cem\u003eN\u003c/em\u003e=60)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"822\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col\u003e\n \u003cli\u003eEDDS\u003csup\u003ea\u003c/sup\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003eCog. Dis.\u003csup\u003eb\u003c/sup\u003e\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.807***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eBinge Eating\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.906***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.552***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eRestriction\u003csup\u003ec\u003c/sup\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.503***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.308*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.278*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"5\"\u003e\n \u003cli\u003eComp. Behs\u003csup\u003ed\u003c/sup\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.446***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.411***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"6\"\u003e\n \u003cli\u003eGender Dysphoria\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.287*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.318*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.267*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"7\"\u003e\n \u003cli\u003eDistal Stress\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.410***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"8\"\u003e\n \u003cli\u003eAge\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"9\"\u003e\n \u003cli\u003eBIPOC Identity\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"10\"\u003e\n \u003cli\u003e\u0026nbsp;Income\u003csup\u003ef\u003c/sup\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.269*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"11\"\u003e\n \u003cli\u003eTransfeminine\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.243*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"12\"\u003e\n \u003cli\u003e\u0026nbsp;Non-Binary\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.305*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.408***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003col start=\"13\"\u003e\n \u003cli\u003e\u0026nbsp;Transmasculine\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.274*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.445***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.558***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003e* \u003cem\u003ep\u003c/em\u003e \u0026lt; .05, ** \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, \u0026nbsp;*** \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003csup\u003ea\u003c/sup\u003eEating Disorder Diagnostic Scale \u0026ndash; Disordered Eating; \u003csup\u003eb\u003c/sup\u003ecognitive distortions, \u003csup\u003ec\u003c/sup\u003ecaloric restriction, \u003csup\u003ed\u003c/sup\u003ecompensatory behaviors, \u003csup\u003ef\u003c/sup\u003eindividuals making over $10,000 a year coded as 1, \u003csup\u003eg\u003c/sup\u003eBIPOC Identity: Black, Indigenous, and other individuals of color coded as 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u0026ndash; Regression Model Predicting Cognitive Distortions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3a.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eb\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e5.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2.336\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eGender Dysphoria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eDistal Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.041\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eTransfeminine\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-1.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-1.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eTransmasculine\u003csup\u003ea\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-4.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-3.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003ePerson of Color\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-3.341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-2.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eIncome \u0026gt; $10,000 a Year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.095\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.046\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.990\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEst. R^2: 0.303, 95% CI [0.119, 0.498]\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003ecompared to non-binary individuals. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3b.\u003c/strong\u003e \u0026ndash; Regression Model Predicting Cognitive Distortions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eb\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2.267\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.812\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eGender Dysphoria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.063\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eDistal Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.041\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eTransfeminine\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.466\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eNon-binary\u003csup\u003eb\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e4.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.288\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e3.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003ePerson of Color\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;-3.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-2.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eIncome \u0026gt; $10,000 a Year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.972\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.100\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 238px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e50.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEst. R^2: 0.299, 95% CI [0.116, 0.495]\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003ecompared to transmasculine individuals. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003e\u0026ndash; Binary Logistic Regression Model Predicting Compensatory Behaviors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4a.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"503\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.596\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eGender Dysphoria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eDistal Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eTransfeminine\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eTransmasculine\u003csup\u003ea\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003ePerson of Color\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eIncome \u0026gt; $10,000 a Year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003ecompared to non-binary individuals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4b.\u003c/strong\u003e \u0026ndash; Regression Model Predicting Cognitive Distortions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"503\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eGender Dysphoria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eDistal Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eTransfeminine\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eNon-binary\u003csup\u003ea\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-1.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003ePerson of Color\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eIncome \u0026gt; $10,000 a Year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003ecompared to transmasculine individuals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"transgender health, disordered eating, gender dysphoria, gender minority stress, discrimination","lastPublishedDoi":"10.21203/rs.3.rs-7093701/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7093701/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Between 2016-2018, Southern U.S. transgender adults (\u003cem\u003eN\u003c/em\u003e = 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy implications:\u003c/strong\u003e Legislative actions that support gender affirming care reduce rates of gender dysphoria, and may in turn reduce disordered eating.\u003c/p\u003e","manuscriptTitle":"Examining Disordered Eating Behaviors Associated with Gender Dysphoria and Minority Stress among Transgender Adults in the Deep South","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 05:41:02","doi":"10.21203/rs.3.rs-7093701/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8342e6bc-3c3a-42ec-93a0-3c18718f1b60","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T16:02:55+00:00","versionOfRecord":{"articleIdentity":"rs-7093701","link":"https://doi.org/10.1007/s13178-025-01220-6","journal":{"identity":"sexuality-research-and-social-policy","isVorOnly":false,"title":"Sexuality Research and Social Policy"},"publishedOn":"2025-10-18 15:58:00","publishedOnDateReadable":"October 18th, 2025"},"versionCreatedAt":"2025-08-08 05:41:02","video":"","vorDoi":"10.1007/s13178-025-01220-6","vorDoiUrl":"https://doi.org/10.1007/s13178-025-01220-6","workflowStages":[]},"version":"v1","identity":"rs-7093701","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7093701","identity":"rs-7093701","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}