"Sacred Restrictions: The Intersection of Religious Trauma and Disordered Eating In Cisgender and Transgender Women and Gender Diverse Individuals

Background and Purpose: Eating disorders and disordered eating represent significant public health concerns and are associated with the highest mortality rate of any psychiatric condition (NEDA, 2015). Research examining social determinants of eating pathology has focused largely on sociocultural pressures such as gender norms and diet culture. However, religion remains underexamined as a potential structural determinant of health. Religious trauma refers to psychological harm resulting from coercive, fear-based, or controlling religious beliefs, practices, and institutions (Panchuk, 2020; Stone, 2013). Emerging evidence suggests that nearly one-third of U.S. adults report experiencing religious trauma (Slade et al., 2023). Women and gender-diverse individuals may be particularly vulnerable due to gendered religious norms that regulate bodies, sexuality, and moral worth (Dietz, 2000; Ramler, 2023). In conceptualizing religion as a structural context shaping health behaviors, this study investigates how religious trauma and related religious factors contribute to the development of disordered eating among cisgender women, transgender women, and femme-identified gender-diverse individuals.

Methods: A cross-sectional mixed-methods survey was conducted with a national sample of 312 adults in the United States who identified as cisgender women, transgender women, or femme-identified gender-diverse individuals and reported adverse religious experiences within Christian contexts. Participants were recruited through a national survey panel using quota sampling. Disordered eating symptoms were measured using the Eating Pathology Symptoms Inventory (EPSI; Forbush et al., 2013). Religious trauma was assessed using the Spiritual Harm and Abuse Scale–Clinical Screener (Koch & Edstrom, 2022). Additional measures included the Attachment to God Inventory (Beck & McDonald, 2004), the Centrality of Religiosity Scale (Huber & Huber, 2012), and the Christian Orthodoxy Scale (Hunsberger, 1989). Hierarchical multiple linear regression analyses examined predictors of disordered eating after controlling for demographic and religious variables. Open-ended survey responses were analyzed using reflexive thematic analysis to contextualize quantitative findings (Braun & Clarke, 2006).

Results: Religious trauma variables significantly predicted disordered eating symptomatology. In hierarchical regression models, religious trauma subscales increased explained variance in disordered eating symptoms to 41.2% (adjusted R² = .412). Controlling leadership (b = 2.08, p < .001), internal distress (b = .50, p = .05), and harmful God-image (b = 1.05, p = .016) emerged as significant predictors. In the final model, controlling leadership (b = 1.68, p < .001), harmful God-image (b = 1.06, p = .012), Christian orthodoxy (b = .21, p = .006), and anxious attachment to God (b = .26, p = .002) remained significant predictors of disordered eating. Qualitative analyses revealed three themes—moral worth, bodily control, and shame and judgment—organized within an overarching theme of social exclusion, illustrating how religious teachings about morality, purity, and discipline shaped participants’ relationships with food and their bodies.

Conclusions and Implications: Findings suggest that religious trauma functions as an underrecognized social and structural determinant of health influencing disordered eating among women and gender-diverse individuals. Implications include integrating religious trauma screening into eating disorder treatment, improving social work training on the health impacts of religious harm, and critically examining institutional religious practices that shape gendered body norms.