The diverging role of embodiment in altered eating behaviors - a comparison between patients with anorexia nervosa and gender dysphoria

Q: What was the study’s main purpose regarding Gender Dysphoria and eating disorders?

To clarify how clinical assessments of eating psychopathology in GD can be expanded beyond behaviors to include the lived experience underlying those behaviors.

Q: How were participants grouped and what tools were used?

The study included 141 GD participants, 153 general-population participants, and 294 anorexia nervosa patients. Body Uneasiness Test (BUT), EDE-Q, and the IDEA questionnaire were administered.

Q: What did the study find about severity across groups?

Body uneasiness and eating behaviors formed a severity spectrum: lowest in the general population, elevated in GD, and highest in patients with anorexia nervosa.

Sep 29, 2026

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Clinical studies report elevated risk for disordered eating and dietary restraint among individuals with Gender Dysphoria (GD), yet assessments often focus on observable behaviors rather than the lived experience beneath them. This study enrolls 141 GD participants, 153 from the general population, and 294 patients with anorexia nervosa, using BUT, EDE-Q, and IDEA. Results show body uneasiness and eating severity rising from the general population to GD and highest in AN, while embodiment disturbances are greatest in AN.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Purpose

Methods

Results

Discussion

Introduction

Definitions: gender incongruence and gender dysphoria

Anorexia nervosa and body-related distress

Embodiment versus negative body image

Vulnerability to disordered eating in GD

Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity (2026) 31:2 [https://doi.org/10.1007/s40519-025-01765-w](https://doi.org/10.1007/s40519-025-01765-w) The diverging role of embodiment in altered eating behaviors: a comparison between patients with anorexia nervosa and gender dysphoria Livio Tarchi1 · Marco Faldi1 · Emanuele Cassioli1 · Eleonora Rossi1 · Luca Zompa1 · Jiska Ristori2 · Alessandra Daphne Fisher2 · Giovanni Stanghellini3,4 · Valdo Ricca1 · Giovanni Castellini1 Received: 27 March 2025 / Accepted: 30 June 2025 © The Author(s) 2025 Abstract Purpose Clinical studies describe a higher risk in individuals with Gender Dysphoria (GD) to engage in disordered eating practices, as well as dietary restraint. To the present day, clinical assessments on eating psychopathology in GD are principally oriented towards assessing behaviors, rather than the lived experience underlying these behaviors. Methods A sample of 141 individuals with GD (40 assigned male at birth—AMAB, 101 assigned female—AFAB), 153 individuals from the general population and 294 patients with AN were enrolled. Body Uneasiness Test (BUT), the Eating Disorders Examination Questionnaire (EDE) and the Identity and Eating Disorders questionnaire (IDEA) were administered. Analysis of variance and linear models were employed to estimate group differences, adjusted for age, education, and body mass index. Results Body uneasiness (BUT global severity index: F value 47.44, p < 0.001), and eating behaviors (EDE total score: F value 66.19, p < 0.001) lied on a spectrum of severity between patients with AN (highest), individuals with GD (elevated) and the general population. Patients with AN reported markedly greater embodiment disturbances in comparison with both the general population and AMAB or AFAB individuals with GD (IDEA total score: minimum T value 4.03, p < 0.001) . However, AMAB individuals with GD also reported moderate embodiment disturbances in comparison with the general population (IDEA total score: T value 3.41, p < 0.01) . Discussion Lived experiences may better highlight core differences between GD and clinical populations of patients with eating disorders. Embodiment disturbances were also reported by AMAB individuals, suggesting a role for gendered expectations in embodiment. Level of evidence III, evidence obtained from cohort or case–control analytic studies. Keywords Gender incongruence · Transgender and gender diverse · Disordered eating · Restrictive eating · Body image · Body dissatisfaction * Giovanni Castellini [giovanni.castellini@unifi.it](giovanni.castellini@unifi.it) 1 Psychiatry Unit, Department of Health Sciences, University of Florence, viale della maternità, Padiglione 8b, AOU Careggi, 50134 Florence, FI, Italy 2 Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy 3 Department of Psychological Sciences, Adjuncto Universidad“Diego Portales”, Santiago, Chile 4 Department of Health Sciences, University of Florence, Florence, Italy Introduction Gender incongruence is described as the condition in which one’s gender identity does not match with sex assigned at birth [1]. The subjective experience of discrepancy between gender identity and the lived, gendered body may be characterized by profound suffering and distress for the individual, a condition which has been referred to as Gender Dysphoria (GD) [2] . On the other hand, Anorexia Nervosa (AN) is described as a severe psychiatric syndrome characterized by persistent disturbances in eating behaviors and associated distress, which can determine remarkable psychosocial dysfunctions [2] . AN has a lifetime prevalence around 0.90–1.42% in women [2], most often develops in adolescence or young adulthood [3] and typically affects females [2], although, in recent years, some studies have observed an increase among males [4]. Both individuals with GD and patients diagnosed with AN repo

FAQs

What was the study’s main purpose regarding Gender Dysphoria and eating disorders?

To clarify how clinical assessments of eating psychopathology in GD can be expanded beyond behaviors to include the lived experience underlying those behaviors.

How were participants grouped and what tools were used?

The study included 141 GD participants, 153 general-population participants, and 294 anorexia nervosa patients. Body Uneasiness Test (BUT), EDE-Q, and the IDEA questionnaire were administered.

What did the study find about severity across groups?

Body uneasiness and eating behaviors formed a severity spectrum: lowest in the general population, elevated in GD, and highest in patients with anorexia nervosa.

Sep 29, 2026

Upload by Hazel