Emotional dysregulation and eating symptoms in help-seeker individuals with gender dysphoria and eating disorders: The mediating role of body uneasiness

Aims: Several researches have posited emotion dysregulation as a key transdiagnostic factor of various conditions, including Eating Disorders (ED) and Gender Dysphoria (GD). Also, a consistent body of literature has recognized the co-occurrence of these two conditions describing the crucial role of body uneasiness, where concerns over body weight, shape, and size may represent strategies to modulate and deal with difficult emotions. The current study aimed to examine whether the different components of body uneasiness have an effect on the association between eating symptoms and emotional dysregulation in these two conditions. Methods: The sample comprised 96 female subjects, of which 32 with anorexia nervosa, 32 with bulimia nervosa treated in a psychodynamic-oriented residential program, and 32 participants assigned female at birth (AFAB) with a diagnosis of DSM-5 GD. Emotional dysregulation was assessed through the Clinical Diagnostic Interview to which the Shedler-Westen Assessment Procedure–200 was applied and participants completed the Eating Disorder Inventory-3 and the Body Uneasiness Test. Results: Significant indirect effects of body uneasiness dimensions in the relation between emotional dysregulation and eating symptoms in ED and GD samples emerged. Overall, only in patients with GD body image related avoidance behavior was a significant mediator, whereas both in patients with ED and with GD feelings of depersonalization toward one’s body mediated the relationship between emotional dysregulation and disordered eating. Discussion: These findings suggest the importance of better understanding the complexity of body-related experiences and the relationship with emotional dysregulation to promote more accurate diagnoses and multidisciplinary and patient-tailored interventions.