Associations Between Gender Diversity and Eating Disorder Symptoms in Early Adolescence

Objective: To assess associations between multiple dimensions of gender diversity with eating disorder symptoms in a national cohort of U.S. early adolescents. Method: This cross-sectional study utilized data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,092, M_age = 12.9 years, 2019–2021). Gender diversity was measured using multiple dimensions, including categorical gender identity (e.g., transgender, cisgender), categorical and continuous felt gender (congruence between gender identity and assigned sex), ordinal gender non-contentedness (dissatisfaction with one's gender), and ordinal gender expression (communication of gender through appearance and mannerisms). Multivariable logistic regression models were used to analyze the associations among gender diversity measures and eating disorder symptoms, adjusting for potential confounders. Results: Greater felt gender diversity was associated with self-worth tied to weight (OR 1.30, 95% CI 1.11–1.53), binge eating (OR 1.24, 95% CI 1.06–1.46), and distress with binge eating (OR 1.32, 95% CI 1.09–1.59). Greater gender expression diversity was associated with self-worth tied to weight (OR 1.16, 95% CI 1.02–1.33), distress with binge eating (OR 1.26, 95% CI 1.04–1.51), and characteristics of binge eating episodes (OR 1.33, 95% CI 1.06–1.66). Gender non-contentedness was associated with self-worth tied to weight (OR 1.38, 95% CI 1.20–1.58) and compensatory behaviors related to weight gain (OR 1.12, 95% CI 1.01–1.26). Transgender identity was not significantly associated with any eating disorder symptoms. Discussion: We found that greater gender diversity across multiple dimensions was associated with various eating disorder symptoms, and that measures beyond binary gender identity may be important to assess gender diversity in early adolescence.