(PS7-A16) Interoceptive Awareness as an Explanatory Factor in the Relationship Between Gender Dysphoria and Restrictive Eating Behaviors Among Transgender and Nonbinary Adults

Research suggests that transgender people display a higher frequency of disordered eating behaviors than cisgender people, despite underrepresentation in the literature. Body dissatisfaction, the negative evaluation of one’s weight, shape, and bodily appearance, appears central to distress in both gender-nonconforming individuals and people diagnosed with eating disorders. Research indicates that gender dysphoric stress can motivate restrictive eating behaviors in transgender populations through the adjustment of incongruent sex-related characteristics associated with body size and shape, including female sex characteristics in transgender men. Despite these findings, the pathways between gender dysphoria and restrictive eating, alongside associated risk factors, remain underexamined. Low interoceptive awareness, or the inability to accurately interpret and tolerate bodily sensations, is a notable risk factor for increased rates of gender dysphoria and disordered eating behaviors. Additionally, transgender individuals often display variable interoceptive accuracy, further suggesting the potential relevance of this factor. Individuals with low interoception may engage in a higher frequency of restrictive eating behaviors to manage gender-incongruent bodily features due to decreased awareness of feelings of hunger and discomfort. This study hypothesized that interoceptive awareness would mediate the relationship between body-related gender dysphoric stress and restrictive eating behaviors.  

250 participants (M_age =26.5, SD_age=7.3) who identified as transgender or nonbinary completed the Gender Dysphoria Scale (GDS), the Multidimensional Assessment of Interoceptive Awareness, second edition (MAIA-2), and the restrictive eating subscale of the Eating Disorder Examination Questionnaire (EDEQ). In this study, 79% of participants identified as White, 10% identified as Black, 10% identified as Latinx, and 1% identified as Indigenous American.

As hypothesized, using the PROCESS Macro, analyses found a significant indirect effect of chest-related gender dysphoria via distracting from bodily sensations (low MAIA-ND) on restrictive eating (IE =0.054, CI [0.05,.112]). Specifically, chest-related gender dysphoria was related to a greater tendency to distract (b=-.107, p< 0.05), which in turn was associated with greater restrictive eating behaviors (b=-.505, p< 0.01).  

Analyses support the hypothesis that greater levels of chest-related gender dysphoria may contribute to a higher frequency of restrictive eating behaviors when individuals distract themselves from uncomfortable bodily sensations. These findings suggest that an increased ability to accurately identify bodily sensations, potentially through acceptance and mindfulness-based interventions, may reduce risk of dysphoria-motivated restrictive eating behaviors in transgender and nonbinary people.