Interpersonal Needs and the Relation Between Eating Disorder Symptoms and Suicidal Ideation Among Transgender and Gender Expansive Adults

Suicide Life Threat Behav. 2026 Apr;56(2):e70099. doi: 10.1111/sltb.70099.

ABSTRACT

BACKGROUND: Transgender and gender expansive (TGE) individuals report elevated rates of eating disorder (ED) symptoms and suicidal ideation (SI). ED symptoms may contribute to SI via impairments in interpersonal functioning, particularly thwarted belongingness (TB) and perceived burdensomeness (PB). Social exclusion (SE) may also account for this relation, though no U.S. studies have tested this. This study explored relations between ED symptoms and SI through TB, PB, and SE in a U.S. TGE sample.

METHOD: Participants (n = 301, 43% gender expansive, M_age = 29 years) recruited nationally through Prolific Academic completed measures at three timepoints: baseline, six-weeks, and twelve-weeks. Exploratory factor analysis evaluated the factor structure of the Interpersonal Needs Questionnaire (INQ). Two mediation path models tested if ED symptoms were associated with current and lifetime SI through interpersonal needs.

RESULTS: A three-factor structure emerged (PB, TB, and SE), replicating prior work identifying the relevance of the SE factor in TGE samples. Cross-sectionally, body dissatisfaction and restriction were indirectly associated with lifetime SI through SE. These relations did not extend longitudinally.

CONCLUSION: Findings support a third factor within the INQ when working with U.S. TGE populations. Further research is warranted to examine SE as a mechanism linking ED symptoms and suicidality among TGE populations.

PMID:42017371 | DOI:10.1111/sltb.70099