Abstract
PurposeGender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations.MethodsThe participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people.ResultsWe present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18–26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18–25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise.ConclusionsGender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.
Highlights
Gender-expansive describes a spectrum of gender identities that do not fit within the binary gender identity system
Plain English summary Gender-expansive describes gender identities that do not fit within the binary gender identity system
Eating disorder attitudes and behaviors in gender-expansive individuals did not differ significantly based on sex assignment at birth
Summary
Gender-expansive describes a spectrum of gender identities that do not fit within the binary gender identity system (i.e., man or woman). This includes those who identify with no particular gender, with some combination of man and woman, and those whose gender identity shifts over time. Only some transgender individuals identify as gender-expansive or non-binary, and not all people who identify as genderexpansive or non-binary identify as transgender. Conflating these distinct groups creates the potential for inaccurate findings relating to distinct groups, marginalizing distinct identities. There is a pressing need to characterize the specific risk factors and mental health outcomes of gender-expansive people
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