Testing the tripartite influence model among Chinese transgender and gender-diverse adults by gender identity

Transgender and gender-diverse (TGD) people face elevated risks for eating and body image disturbances relative to their cisgender counterparts. The tripartite influence model has been widely validated in general populations; however, there is limited evidence on its applicability among TGD adults. Existing studies have also often aggregated individuals with different gender identities and have been primarily conducted in Western cultural contexts. Accordingly, the suitability of the tripartite influence model in non-Western cultural contexts (e.g., China) remains unknown. To fill these gaps, this study examined the tripartite influence model in Chinese TGD adults by gender identity. Participants included 407 TGD adults in China recruited online (142 transgender women, 92 transgender men, and 173 gender-diverse individuals). All participants completed measures assessing core variables in the model. We conducted group mean comparisons to examine group differences in tripartite influence model variables and used multi-group path analyses to test the hypothesized pathways of the tripartite influence model across gender identity groups. Results showed that transgender women reported higher thin-ideal internalization, body fat dissatisfaction, and thinness-oriented disordered eating than transgender men and gender-diverse participants; transgender men reported higher muscular-ideal internalization and muscularity dissatisfaction than the other groups; and gender-diverse participants showed intermediate levels in most variables. Appearance pressures were directly related to eating disturbances and indirectly related through internalized body ideals and body dissatisfaction. Findings underscore heterogeneity across TGD subgroups in China and partially support tripartite processes, while indicating model refinements are needed for TGD adults. Tailored prevention and intervention efforts should consider distinct risk pathways related to eating disturbances by gender identity.