Eating Disorder Symptoms, Body Satisfaction, and Self-Esteem Among Dutch Mental Health Outpatient Youth With Gender Incongruence

de Groot, Michelle
van Hoeken, Daphne
Keski-Rahkonen, Anna

Department Youz, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
Department of Public Health, University of Helsinki

M. Paz Galupo served as action editor.

We thank Kyra Tempelaar for her contribution to data collection and curation and Mathijs Deen for his statistical advice. Data of the study are available on request to Michelle de Groot. Acknowledging that our identities can influence our approach to science (Roberts et al., 2020), the authors wish to provide the reader with information about their backgrounds when the article was drafted: with respect to gender, all authors self-identified as woman or gender diverse; with respect to race, all authors self-identified as diverse North European. Our gender identities allowed us to appreciate the construct of gender diversity beyond the binary construct. It also helped us understand the importance of addressing gender diversity in scientific research among persons with eating disorders. If our references do not represent the diversity of gender, race, geography, seniority and other factors, this was unintentional or unavoidable. The large majority of studies in the field of eating disorders have used a binary approach of gender, and many have focused on the high-risk group of young persons assigned with the female gender at birth and were carried out in Western countries.

Michelle de Groot, Department Youz, Parnassia Psychiatric Institute, Max Euwelaan 70, 3062 MA Rotterdam, The Netherlands [email protected]

Received June 28, 2024

revised April 7, 2025

Accepted April 7, 2025

Psychology of Sexual Orientation and Gender Diversity Publish Ahead of Print, June 30, 2025. | DOI: 10.1037/sgd0000846

International research indicates that transgender and gender diverse persons are at high risk of developing an eating disorder (ED). Despite a sharp increase in demand for transgender care in the Netherlands, so far no study has examined the risk of developing EDs among Dutch youth with gender incongruence. The aims of this study are to investigate the proportion of gender-incongruent youth at increased risk of developing an ED, assess their ED symptom severity, and compare body satisfaction and self-esteem between those at increased versus low risk of an ED. Gender-incongruent youth referred to outpatient mental health care (N = 132) filled out the InsideOut Institute-Screener for risk of ED, the Body Image Scale, and the Global Self-Esteem subscale of the Self-Perception Profile for Adolescents. Participants with a score above cutoff on the InsideOut Institute-Screener were administered the Eating Disorder Examination Questionnaire 6.0. Up to 47.7% of the participants (M_age = 18.4, SD = 1.8) were at increased risk of an ED. Of them, 74.6% had high ED symptom scores. Participants at increased risk of an ED reported lower body satisfaction and self-esteem than those at low risk. Almost half of Dutch gender-incongruent youth referred to outpatient mental health care were at increased risk of an ED. They reported high levels of ED symptoms and lower body satisfaction and self-esteem than those at low risk. These findings highlight the need to assess ED symptoms in gender-incongruent persons seeking mental health care.