Emotion dysregulation and thinness- and muscularity-oriented eating disorder symptoms in Chinese transgender and gender-diverse adults: a network perspective

Transgender and gender-diverse (TGD) individuals face a heightened risk of emotion dysregulation and eating disorders (EDs) compared to their cisgender counterparts. However, limited research has investigated the relation between emotion dysregulation and ED symptoms among TGD adults, particularly within the Chinese cultural context. The present study aimed to employ network analysis to examine symptom-level associations between emotion dysregulation and thinness- and muscularity-oriented ED symptoms in a sample of Chinese TGD adults. Participants included 410 TGD individuals (142 transgender women, 92 transgender men, and 176 gender-diverse adults e.g. non-binary individuals). Separate network analyses by TGD groups revealed distinct symptom interaction patterns, each with four identified communities. Regarding central symptoms, shape/weight preoccupation emerged as the most central node in transgender women and gender-diverse adults, whereas nonacceptance of emotional responses was the most central node in transgender men. Bridge node analysis identified specific symptoms connecting emotion dysregulation to ED symptoms, with the use of meal replacement supplements when full and nutrition anxiety when eating out as the most essential in transgender women; food/eating/calorie preoccupation in transgender men; and food restriction for shape or weight concerns and nutrition anxiety when eating out in gender-diverse individuals. Findings provide empirical support for meaningful heterogeneity in the interplay between emotion dysregulation and ED symptoms across transgender women, transgender men, and gender-diverse individuals. This underscores the critical need to move beyond one-size-fits-all approaches and develop tailored interventions that address the unique emotional and body image regulation challenges faced by transgender women, transgender men, and gender-diverse individuals.