A mixed methods exploration into body-related gender euphoria and eating disorders in trans and/or nonbinary autistic adults.

Transgender is an umbrella term used in Western Europe and North America for individuals whose gender differs from the gender socially attributed to their assigned sex at birth (Tebbe & Budge, 2022). Autistic describes individuals who share a pattern of high synaptic connectivity and responsiveness in the brain leading to differences in thinking, moving, sensing, and communicating (Walker, 2021).

Transgender and/or nonbinary (TNB) and autistic populations experience high rates of psychological distress compared to cisgender and non-autistic populations (Lai et al., 2019; Pinna et al., 2022). Gender diversity and autistic traits overlap, with many individuals being both TNB and autistic (Gratton et al., 2023). A small but growing number of studies have shown that rates of psychological distress may be particularly high in adults who are both TNB and autistic (Bouzy et al., 2023).

Eating disorders are a group of mental health issues including anorexia nervosa (AN), bulimia nervosa (BN) binge eating disorder (BED), and avoidant-restrictive food intake disorder (ARFID) (International Classification of Diseases (ICD), 2021). They are characterised by distressing thoughts, feelings and behaviours around food and eating, and body weight and shape.

As many as 30% of TNB adults, and separately of autistic adults, may meet the diagnostic criteria for an eating disorder (Nickel et al., 2019, Pinna et al., 2022). A single case series of three young TNB autistic people has examined eating disorders in this population (Pham et al., 2021). This highlighted the complex interaction of body-related gender dysphoria and autistic traits in the development of avoidant and restrictive eating patterns in TNB autistic youth.

There is a need for mixed-methods research on this topic with larger samples to explore the generalisability of these findings.

Community experts have recommended that research with this population must place an equal weight on resilience and predictors of wellbeing when examining mental health issues (Gratton et al., 2023). Therefore, alongside disordered eating, this PhD will seek to explore eating disorder resilience and recovery. The experience of gender dysphoria may differ in TNB autistic adults (Cooper et al., 2023), therefore this pathway for eating disorder development and recovery in TNB autistic adults needs to be further explored.

This PhD will specifically examine the role of body-related gender euphoria as a possible protective factor against eating disorders. Aims and Objectives

This PhD will conduct a series of three studies to explore gender euphoria and disordered eating in adults who are autistic and also TNB. This PhD seeks to answer the following research questions: 1) What is the experience of disordered eating like for TNB autistic adults? 2) What is a valid and acceptable self-assessment tool for gender dysphoria/euphoria in autistic and non-autistic TNB adults? 3) Does gender dysphoria/euphoria have a role in predicting eating disorder-related outcomes in TNB autistic adults?