Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students.
OBJECTIVE
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.
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
Elizabeth W
EW
Diemer
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
Julia D
JD
Grant
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
Melissa A
MA
Munn-Chernoff
George Warren Brown School of Social Work, Washington University, St. Louis, Missouri.
David A
DA
Patterson
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri; George Warren Brown School of Social Work, Washington University, St. Louis, Missouri. Electronic address: aduncan@wustl.edu.
Alexis E
AE
Duncan
D000293:Adolescent; D000328:Adult; D019440:Anti-Obesity Agents / Q000008:administration & dosage; D019587:Dietary Supplements / Q000706:statistics & numerical data; D001068:Feeding and Eating Disorders / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005783:Gender Identity; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D057566:Self Report; D012725:Sexual Behavior; D013334:Students / Q000523:psychology*; D063106:Transgender Persons; D014481:United States / Q000453:epidemiology; D014495:Universities; D014839:Vomiting; D055815:Young Adult
D019440:Anti-Obesity Agents; D054368:Laxatives
College students; Compensatory behaviors; Eating disorders; Gender identity; Sexual orientation