Examining the associations of thwarted belongingness and perceived burdensomeness with eating disorder symptoms in Chinese gender-diverse adults: The mixed role of appearance congruence.

Eating disorder (ED) symptoms and suicidality are marked psychological concerns and health disparities among gender-diverse individuals relative to their cisgender counterparts, yet little research has examined interpersonal suicidal processes that may be linked to ED symptoms, particularly in non-Western contexts. Guided by the Interpersonal-Psychological Theory of Suicide, the present cross-sectional, online study investigated associations between perceived burdensomeness, thwarted belongingness, and traditional and muscularity-oriented ED symptoms in Chinese gender-diverse adults. Participants were transgender women (n = 142), transgender men (n = 92), and non-binary and other gender-diverse individuals (n = 176). Self-report measures captured constructs of interest. In general, bivariate correlations suggested positive associations between perceived burdensomeness, thwarted belongingness, and traditional and muscularity-oriented ED symptoms across gender identity groups. We tested two types of transgender congruence (appearance congruence and gender identity acceptance) as moderators of these associations. At the uncorrected p < .05 level, appearance congruence moderated several associations involving thwarted belongingness and perceived burdensomeness and ED symptoms. After false discovery rate correction, the moderation of appearance congruence on the association between thwarted belongingness and traditional ED symptoms in transgender men remained significant. Clinicians and researchers alike may consider the role of thwarted belongingness and perceived burdensomeness when working with gender-diverse individuals with ED symptoms. Appearance congruence should be considered carefully alongside aspects such as gender identity expression and the role of ED symptoms in supporting (or not) gender identity expression, as these may be relevant to thwarted belongingness and perceived burdensomeness among gender-diverse individuals.