“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.

Cusack, Claire E.; Iampieri, Alan O.; Galupo, M. Paz

doi:10.1037/sgd0000515

Cited by 59Eating Disorders and BehaviorsLGBTQ Health, Identity, and PolicyBody Image and Dysmorphia Studies

“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.

Cusack, Claire E., Iampieri, Alan O., Galupo, M. Paz·2022·Psychology of Sexual Orientation and Gender Diversity

DOI 10.1037/sgd0000515

Open this paper in CoChat — free account

Integrity signals

Registry

Crossref · 10.1037/sgd0000515

Cites

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

The socio-cultural and political environment is an important contextual factor in an individual's healing and recovery.
“The socio-cultural and political environment for an individual is an important contextual factor in their healing and recovery (i.e., moralisation of food, desire, appetite and health; discrimination against diverse bodies, expressions, and neurodiversity [129–138]).”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [132]

Sorted by citations

A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope
Elwyn, R. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-022-00729-0 · Cited by 61 · see citing works
Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment
McGregor, K., McKenna, J. L., Barrera, E. P., Williams, C. R., Hartman-Munick, S. M., & Guss, C. E. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00793-0 · Cited by 38 · see citing works
A qualitative exploration of positive body image experiences among nonbinary individuals
Ogle, J. P., Johnson, A. N., Reddy-Best, K. L., Harmon, J., Morris, K. D., & Kittersong, P. (2023) · Body Image · doi:10.1016/j.bodyim.2023.101632 · Cited by 34 · see citing works
Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States
Goetz, T. G., & Wolk, C. B. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24055 · Cited by 30 · see citing works
Two identical twin pairs discordant for longstanding anorexia nervosa and OSFED: lived experience accounts of eating disorder and recovery processes
Elwyn, R., Williams, M., Smith, E., & Smith, S. E. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01078-w · Cited by 24 · see citing works
“Unmet needs in treat-ment (i.e., AN and ARFID co-occurrence 3 , trauma, gender dysphoria)[137, 167–172] and the physical impacts of severe and chronic AN [173–175] also maintained severe illness, hopelessness, and longstanding AN duration.”
Background
Does body positivity work for men as it does for women? The impact of idealized body and body positive imagery on body satisfaction, drive for thinness, and drive for muscularity
Fasoli, F., & Constantinou, D. (2024) · Acta Psychologica · doi:10.1016/j.actpsy.2024.104126 · Cited by 23 · see citing works
Social and contextual influences on eating pathology in transgender and nonbinary adults
Urban, B., Knutson, D., Klooster, D., & Soper, J. (2022) · Eating Disorders · doi:10.1080/10640266.2022.2135715 · Cited by 19 · see citing works
“Experiences of gender dysphoria may contribute to patterns of EP in TNB individuals (Cusack et al., 2022).”
BackgroundMethod
‘Let the ladies know’: queer women’s perceptions of how gender and sexual orientation shape their eating and weight concerns
Simone, M., Askew, A. J., Beccia, A. L., et al. (2023) · Culture Health & Sexuality · doi:10.1080/13691058.2023.2189931 · Cited by 16 · see citing works
“Highly relevant across the study themes were references to various body shapes being ‘feminine’, ‘masculine’ and ‘androgynous’, as observed in prior qualitative work (Cusack et al. 2022).”
ResultSelf-citation
Eating disorder symptoms among transgender and gender diverse youth
KRAMER, R. A., Peterson, C. M., Conard, L. A. E., Lenz, K. R., & Matthews, A. L. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231184917 · Cited by 16 · see citing works
“…including body dissatisfaction, laxative and diet pill use, steroid abuse, self-induced vomiting, binge eating episodes, and fasting behaviors (Cusack et al., 2022; Diemer et al., 2015 Mirabella et al., 2020; Nagata et al., 2020; Vocks et al., 2009; Watson et al., 2017; Witcomb et al., 2015).”
Background
“ The third table where I would sit comfortably ”: narratives of nonbinary identity routes
Giannantonio, B. D., Milanese, K., Massimiliano Mirabella, A., Rosati, F., Lorusso, M. M., Pistella, J., Baiocco, R., Lingiardi, V., & Giovanardi, G. (2024) · International Journal of Transgender Health · doi:10.1080/26895269.2024.2303466 · Cited by 16 · see citing works
Next Steps in Use of the Eating Disorder Examination and Related Eating Disorder Assessments: A Call for Consensus
Reilly, E. E., Gorrell, S., Chapa, D. A. N., Drury, C. R., Stalvey, E., Goldschmidt, A. B., & Grange, D. L. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24378 · Cited by 16 · see citing works
The future of the eating disorder field: Inclusive, aware of systems, and personalized
Levinson, C. A., Cusack, C. E., Hunt, R. A., Fitterman-Harris, H. F., Ralph‐Nearman, C., & Hooper, S. C. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104648 · Cited by 14 · see citing works
Self-citation
Emotional dysregulation and eating symptoms in gender dysphoria and eating disorders: the mediating role of body uneasiness
Mirabella, M., Carone, N., Franco, A., Rugo, M. A., Speranza, A. M., Mazzeschi, C., Lingiardi, V., & Muzi, L. (2024) · Current Psychology · doi:10.1007/s12144-024-05663-9 · Cited by 12 · see citing works
“Qualitative studies have also suggested that ED symptoms may func - tion as (dysfunctional) strategies for coping with the distress associated with proximal stressors related to one’s transgen - der identity, including internalized transphobia (Cusack et al., 2022 ).”
Influential
Prevalence of Disordered Eating Behaviors Among Sexual and Gender Minority Youth Varies at the Intersection of Gender Identity and Race/Ethnicity
Forrest, L. N., Bennett, B. L., Beccia, A. L., Puhl, R. M., & Watson, R. J. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24352 · Cited by 12 · see citing works
“…and gender-diverse people is likely due to several non-mutually exclusive sources at individual, interpersonal, and structural levels of influence (Cusack, Iampieri, and Galupo 2022; Simone et al. 2024; Urban et al. 2024), and these drivers may differentially impact individuals over time (e.g.,…”
Avoidant/restrictive food intake disorder (ARFID) symptoms in gender diverse adults and their relation to autistic traits, ADHD traits, and sensory sensitivities
Thomas, K. S., Keating, J., Ross, A. A., Cooper, K., & Jones, C. R. G. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01215-z · Cited by 14 · see citing works
Eating disorder symptomatology among transgender and gender-diverse individuals: a cross-sectional study
Rasmussen, S., Clausen, L., Pop, M. L., Højgaard, A. D., Kjeldsen, M. K., & Telléus, G. K. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01212-2 · Cited by 14 · see citing works
Nutritional considerations for gender-diverse people: a qualitative mini review
Mittertreiner, E. J. E., Hunter, A., & Lacroix, E. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1332953 · Cited by 11 · see citing works
Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study
Li, J., Feng, Y., Yu, Y., Xu, S., & Wang, Y. Y. (2024) · BJPsych Open · doi:10.1192/bjo.2024.18 · Cited by 9 · see citing works
Eating disorders among queer and trans individuals: Implications for conceptualization, assessment, and treatment
Cusack, C. E., Silverstein, S., Askew, A. J., Simone, M., Galupo, M. P., & Levinson, C. A. (2024) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2024.88.2.128 · Cited by 7 · see citing works
Self-citation
Disordered eating in autistic trans and gender diverse people: a lived experience-led scoping review
White, L., Schweizer, K., & Thomas, K. S. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01447-z · Cited by 7 · see citing works
The impact of gender affirming care on eating disorder symptoms and body dissatisfaction: A systematic review and meta-analysis amongst transgender and gender diverse populations
Doley, J. R., Lilley, M., Marmara, J., Rodgers, R. F., & Laveway, K. (2025) · Body Image · doi:10.1016/j.bodyim.2025.102020 · Cited by 5 · see citing works
Community norms of the Eating Pathology Symptoms Inventory (EPSI) in transgender and gender-diverse adults
Nagata, J. M., Otmar, C. D., Lee, C. M., et al. (2025) · Eating Behaviors · doi:10.1016/j.eatbeh.2025.101993 · Cited by 5 · see citing works
Ecological momentary assessment of state affect prior to and following loss of control eating in young men
Williamson, G., Cotter, E. W., Cao, L., Guidinger, C., & Kelly, N. R. (2023) · Eating Behaviors · doi:10.1016/j.eatbeh.2023.101782 · Cited by 5 · see citing works
Validation of the Multidimensional Assessment of Interoceptive Awareness Scale in a Sample of Transgender and Gender-Diverse Adults
Frietchen, R. E., Miller, M. G. B., Denning, D. M., Smith, A. R., & Brown, T. A. (2025) · Assessment · doi:10.1177/10731911241308085 · Cited by 4 · see citing works
“In addition, these findings align with qualitative studies on disordered eating in TGD people that highlight how low body trust may relate to disordered eating (Cusack, Iampieri, & Galupo, 2022; Duffy et al., 2016; Pham et al., 2023).”
Transgender and gender diverse consumers on navigating the stigmatized process of gender affirmation in the Central Plains USA
Meyer, H. M., Mocarski, R. A., Holt, N. R., Hope, D. A., & Woodruff, N. (2023) · Qualitative Market Research An International Journal · doi:10.1108/qmr-04-2021-0045 · Cited by 4 · see citing works
Orthorexia nervosa symptomatology in the LGBTQ community: Gender and sexual orientation differences
Noebel, N. A., Vela, R. B., Arreguin, D. H., & Oberle, C. D. (2023) · Eating Behaviors · doi:10.1016/j.eatbeh.2023.101771 · Cited by 5 · see citing works
Cognitive restraint and body dissatisfaction are more strongly related to muscle building behaviors for men than women
Patarinski, A. G. G., Garban, A. L., Athanasaw, K., Murray, M. F., & Davis, H. A. (2025) · Eating Behaviors · doi:10.1016/j.eatbeh.2025.101941 · Cited by 4 · see citing works
Potential Harm in the Psychological Treatment of Sexual and Gender Minority Youth
Pinciotti, C. M., Cusack, C. E., Rodriguez-Seijas, C., Lorenzo‐Luaces, L., van Dyk, I. S., & Galupo, M. P. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01268-9 · Cited by 5 · see citing works
“…of ED symptoms may differ for this population compared to cisgender heterosexual adolescents, such as to achieve a gender expression congruent with one’s gender identity or sexual orientation, mitigate gender dysphoria, or punish oneself (Cusack, Iampieri et al., 2022a; Parker & Harriger, 2020).”
Self-citation
Social-Contextual Influences on Eating Pathology in Transgender and Nonbinary Adults of Color
Urban, B., Knutson, D., & Lazo-Salmeron, W. (2024) · Journal of LGBTQ Issues in Counseling · doi:10.1080/26924951.2024.2326614 · Cited by 4 · see citing works
How Do the Psychological Functions of Eating Disorder Behaviours Compare with Self-Harm? A Systematic Qualitative Evidence Synthesis
Ambler, F., Hill, A. J., Willis, T. A., Gregory, B., Mujahid, S., Romeu, D., & Brennan, C. A. (2025) · Healthcare · doi:10.3390/healthcare13151914 · Cited by 3 · see citing works
“This function appeared particularly relevant for transgender and gender diverse individuals who frequently discuss using ED behaviours as an attempt to suppress or alter their physical characteristics in an attempt to feel more gender-aligned [70,90,92,93,108,110,111].”
Correlates of body dissatisfaction and eating disorder symptoms in transgender and gender diverse populations: A systematic review
Laveway, K., Rodgers, R. F., Spagnolo, J., Uyar, R., Marmara, J., & Doley, J. R. (2026) · Body Image · doi:10.1016/j.bodyim.2025.102029 · Cited by 3 · see citing works
Emotion dysregulation and thinness- and muscularity-oriented eating disorder symptoms in Chinese transgender and gender-diverse adults: a network perspective
(4595770), Z. W., Barnhart, W. R., Yim, S. H., Sahlan, R. N., Li, Y., Nagata, J. M., & He, J. (2026) · Eating Disorders · doi:10.1080/10640266.2026.2616483 · Cited by 2 · see citing works
Trans Young People and Embodiment
Riggs, D. W., & Rosenberg, S. (2023) · Springer eBooks · doi:10.1007/978-981-4451-96-3_70-1 · Cited by 2 · see citing works
Reasons for Genital Dissatisfaction in a Sample of Brazilian Men
da Silva, E. V., Braz, M. M., & Pivetta, H. M. F. (2024) · Archives of Sexual Behavior · doi:10.1007/s10508-024-02818-4 · Cited by 3 · see citing works
“Furthermore, previous research has shown that this occurs as a way of coping with the distress associated with gender dysphoria, body dissatisfaction, harassment, sexual objectification, and stress (Brewster et al., 2019; Cusack et al., 2022).”
Cross-Sectional Relationships Between Gender, Disordered Eating Behaviors, and Suicide Among High Schoolers in Colorado
Anderson, A. M., Rosenberg, S., Schier, H. E., Eskew, S. K., Harpin, S. B., Brooks‐Russell, A., & Sun, C. J. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22020152 · Cited by 2 · see citing works
“TGD individuals may engage in disordered eating to alter their bodies, and these changes can potentially exacerbate or alleviate their gender dysphoria and related identity conflicts [25,26].”
Health Consequences of Familial Negative Weight Talk Across the Spectrum of Gender Diversity
Rancaño, K. M., & Lawrence, S. E. (2023) · Current Nutrition Reports · doi:10.1007/s13668-023-00501-z · Cited by 2 · see citing works
“…to try to mask or eliminate physical characteristics of their sex assigned at birth (e.g., alter body fat composition to obscure secondary sex characteristics, such as breasts) and/or induce characteristics societally construed to be associated with their gender (e.g., small waist) [9, 10, 67, 68].”
Evidence That the DSM‐5‐TR Eating Disorder Criteria Perform Differently Across Cisgender and Transgender or Gender Diverse Individuals Using the Eating Disorder Diagnostic Scale
Sharma, A. R., Bottera, A. R., Joo, S., et al. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24554 · Cited by 1 · see citing works
Examining Disordered Eating Behaviors Associated with Gender Dysphoria and Minority Stress among Transgender Adults in the Deep South
Botelho, E., Borgatti, A. C., Carrera, S. T., Edwards, R. D., Spann, N. S., & Wolford‐Clevenger, C. (2025) · Sexuality Research and Social Policy · doi:10.1007/s13178-025-01220-6 · Cited by 1 · see citing works
Context matters: reconsidering resilience factors in dehumanization pathways to dysfunctional eating among transgender and gender diverse individuals
Bonato, M., Cherchi, B., Meneguzzo, P., Ronconi, L., Scala, A., Tascini, B., Gatta, M., Garolla, A., & Miscioscia, M. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1788398 · Cited by 1 · see citing works
Testing the tripartite influence model among Chinese transgender and gender-diverse adults by gender identity
Cheng, Y., Li, Y., Barnhart, W. R., Wang, P., Sahlan, R. N., Wu, S., Jiang, Z., Nagata, J. M., Ji, F., & He, J. (2026) · Body Image · doi:10.1016/j.bodyim.2026.102106 · Cited by 1 · see citing works
Mental health and body image among SGM youth engaged with a digital eating disorder intervention
Kasson, E. M., Szlyk, H. S., Li, X., Sirko, G., Rehg, I., Vázquez, M. M., Wilfley, D. E., Taylor, C. B., & Fitzsimmons‐Craft, E. E. (2024) · International journal of LGBTQ+ youth studies. · doi:10.1080/19361653.2024.2375519 · Cited by 1 · see citing works
“…Kwon, 2023), however experiences of social comparison and interpretation of body ideals may vary and impact individuals differently based on their gender and/or sexual identities (Cusack et al., 2022; Cusack & Galupo, 2021; Galupo et al., 2021), marking an area for future research among SGM teens.”
Weight concern and desire for weight loss support in adolescents: Results from a large cross‐sectional school survey
(2026) · doi:10.1002/jcv2.70124
“Nevertheless, evidence suggests that weight - related perceptions remain closely intertwined with gender identity and affirmation and that these are often linked to body weight among gender minority individuals (Cusack et al., 2022).”
The Role of Gender Affirmation in Eating Disorder Symptoms in Transgender Individuals
Strahl, J. (2022) · doi:10.15760/honors.1246
Functional Assessment of Disordered Eating in the Context of Trauma and Sexual AssaultPreprint
Georgeaux‐Healy, C. (2023) · doi:10.31234/osf.io/txymj
Trans Young People and Embodiment
Riggs, D. W., & Rosenberg, S. (2024) · Springer eBooks · doi:10.1007/978-981-99-8606-4_70
Eating Disorders
Forbush, K. T., Bohrer, B. K., Thomeczek, M. L., Negi, S., Chapa, D. A. N., Christensen, K. A., Sharma, A. R., Exum, A. C., Richson, B. N., & Voss, M. M. (2025) · Springer eBooks · doi:10.1007/978-1-0716-4362-4_13
Stories of clinical care in transgender and nonbinary individuals with eating pathology: a scoping review
Giannantonio, B. D., Buglio, G. L., Mirabella, M., Boldrini, T., Franco, A., Rugo, M. A., Lingiardi, V., & Muzi, L. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2520975 · Cited by 1 · see citing works
A qualitative insight into the experience of self-oriented body comparison in postpartum women
Vashro, T. N., Thompson, K. A., Mazzeo, S. E., et al. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101981
Appetizing food cues most consistently relate to men's same-day loss of control eating
Kelly, N. R., Kosty, D. B., & Cotter, E. W. (2025) · Eating Behaviors · doi:10.1016/j.eatbeh.2025.102063
Understanding risk and resiliency in transmasculine pregnancy: An application and biopsychosocial extension of the Gender Minority Stress Theory
Coward, C. O., Swaminathan, K., Hahn‐Holbrook, J., & Howell, J. L. (2026) · International Journal of Transgender Health · doi:10.1080/26895269.2026.2656939
“People Who Get You”: A Qualitative Study of LGBTQ+-Affirming Eating Disorder Treatment
Peters, S. M., Salvia, M. G., & Quatromoni, P. A. (2026) · The Counseling Psychologist · doi:10.1177/00110000261441609
Associations between socio-demographic patterns, body dissatisfaction, and eating disorder risk in women: a cluster-based approach
Juergensen, V., Halbeisen, G., Lehe, M. S., & Paslakis, G. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01616-8
“The intersections between gender dysphoria-defined as psychological distress resulting from a mismatch between gender identity and assigned sex at birth-body image concerns, and EDs require greater attention [68].”
Exploring the roles of gender identity and neurodivergence in the development of eating disorders among trans and gender diverse people – a large-scale qualitative studyPreprint
Thomas, K. S., Keith, M., Williams, G. T., Blackbrook, H., Bainbridge, R., Merry, J., LEADING Lived Experience Advisory Group, Williams, M. O., Henley, J., Jones, C. R. G., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-9556606/v1 · Cited by 1 · see citing works
Multiple identities, diverse stories: A focus group study on the experiences of sex education among queer individuals with multiple marginalized identities
Decaro, S. P., Gemignani, M., & Giacomozzi, M. (2026) · Methods in Psychology · doi:10.1016/j.metip.2026.100279 · Cited by 1 · see citing works
Eating Disorders in Transgender, Non‐Binary, and Gender Diverse Populations: A Meta‐Synthesis of Qualitative Findings
Matthews, K., Thomas, K. S., Fox, J. R. E., Nathwani, F., & Williams, M. O. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70228
Applying Bisexual Minority Stress and Body Dissatisfaction to a Model of Body Image Concern for Bisexual Adults
DeLucia, R., Smith, N. G., Fan, W., King, B., & Soltis, D. (2026) · Journal of Bisexuality · doi:10.1080/15299716.2026.2738207
Development and validation of the Trans Disordered Eating Scale: a novel measure of disordered eating among trans and gender diverse adults
Urban, B., & Knutson, D. (2026) · Eating Disorders · doi:10.1080/10640266.2026.2737198

Authors: Cusack, C. E., Iampieri, A. O., & Galupo, M. P.
ORCID: Cusack, Claire E.
Iampieri, Alan O.
Galupo, M. Paz
Venue: Psychology of Sexual Orientation and Gender Diversity
Publisher: American Psychological Association (APA)
Published: 2022-12
Volume: 9
Issue: 4
Pages: 422-433
ISSN: 2329-0382 (ISSN-L)
2329-0390
DOI: 10.1037/sgd0000515
OpenAlex: W4210615357
Cited by: 59
References: 0
Citations by year: 2026: 13 · 2025: 18 · 2024: 13 · 2023: 13 · 2022: 2
FWCI: 10.52
Type: journal article
Language: en
Open access: closed
Locations: Psychology of Sexual Orientation and Gender Diversity (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
Keywords: eating disorders, gender dysphoria, transgender people, non-binary people, body image concern, eating concerns, gender identity, etiology of eating disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

“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.

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cited by

Related

Record

About these checks