Gender identity, sexual orientation, and eating-related pathology in a national sample of college students
Open accessAbstract
Purpose This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students.Methods Data came from 289,024 students from 223 U.S. universities participating in the American College Health Association-National College Health Assessment II (median age, 20 years). Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5,977) and female (n = 9,445), unsure male (n = 1,662) and female (n = 3,395), and heterosexual male (n = 91,599) and female (n = 176,467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates.Results Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were highest among transgender students and lowest among cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past-year SR-ED diagnosis (odds ratio [OR], 4.62; 95% confidence interval [CI], 3.41-6.26) and past-month use of diet pills (OR, 2.05; 95% CI, 1.48-2.83) and vomiting or laxatives (OR, 2.46; 95% CI, 1.83-3.30). Although cisgender SM men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than those for transgender individuals (ORs; 1.40-1.54).Conclusions Transgender and cisgender SM young adults have elevated rates of compensatory behavior and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.
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A large study of U.S. college students found transgender students were significantly more likely to report a past-year diagnosis of anorexia nervosa or bulimia nervosa and past-month compensatory behaviors than cisgender peers.
“Similarly, a large study of U.S. college students found transgender students were significantly more likely to report a past-year diagnosis of anorexia nervosa or bulimia nervosa and past-month compensatory behaviors than cisgender peers (Diemer et al., 2015).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Diemer et al., 2015
Extant literature provides support for TGAs being at increased risk for disordered eating.
“Extant literature provides support for TGAs being at increased risk for disordered eating.”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Diemer et al., 2015
Both case studies and quantitative literature have found purging behaviors to be prevalent among TGAs.
“Furthermore, both case studies and quantitative literature have found purging behaviors to be prevalent among TGAs (Diemer et al., 2015; Watson et al., 2017; Gordon et al., 2016).”
From Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth (2021) · cites this paper as Diemer et al., 2015
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- Authors
- Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Duncan, Alexis E.
- Venue
- Journal of Adolescent Health
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 57
- Issue
- 2
- Pages
- 144-149
- ISSN
- 1054-139X (ISSN-L)
- PMC
- PMC4545276
- OpenAlex
- W2017448670
- Cited by
- 460
- References
- 39
- Citations by year
- 2026: 33 · 2025: 42 · 2024: 57 · 2023: 78 · 2022: 44 · 2021: 55 · 2020: 47 · 2019: 38 · 2018: 31 · 2017: 17 · 2016: 17 · 2015: 1
- FWCI
- 27.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Adolescent Health (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Alcohol Abuse and Alcoholism (T32-AA07580, K23AA017684, R21AA021235, T32AA007580, R01AA017915)
- National Institute on Drug Abuse (R01DA023668)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- gender identity, sexual orientation, eating disorders, transgender students, compensatory behavior, weight loss pills, vomiting, laxative use, university students, young adults, sexual minority men
- MeSH terms
- Adolescent, Adult, Feeding and Eating Disorders, Female, Gender Identity, Health Surveys, Humans, Male, Risk Factors, Sexual Behavior, Students, United States, Universities, Vomiting, Logistic Models, Odds Ratio, Anti-Obesity Agents, Dietary Supplements, Laxatives, Young Adult, Self Report, Transgender Persons
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