Feminine Gender Norms Among Women with Eating Disorders: Findings from an Exploratory Pilot Study

Abstract

Eating disorders are multifactorial mental health conditions that predominantly affect adolescent girls and young women and constitute a major public health concern due to their severe and often chronic impact on physical, psychological, and psychosocial functioning. Although existing research suggests that gender-related constructs and traditional gender roles may be associated with the development and expression of eating disorders, empirical evidence using validated measures remains limited. Accordingly, the present study examines health-related variables from a gender-sensitive perspective in a clinical sample of women diagnosed with an eating disorder. Forty women aged 14 to 50 years completed an assessment protocol including measures of gender norms, eating disorder symptoms, mental health, and self-perceived overall health. Results indicated that poorer mental health and self-perceived overall health were significantly associated with higher levels of eating disorder symptomatology. In an exploratory hierarchical regression analysis, overall conformity to traditional feminine gender norms was associated with eating disorder symptomatology after accounting for health-related variables. Exploratory analyses of individual gender norm dimensions indicated that only a small number of associations remained statistically significant after applying a false discovery rate correction. In sum, within the limitations of a modest and heterogeneous clinical sample, the findings suggest that conformity to traditional feminine gender norms is associated with less favorable health indicators and greater eating disorder symptomatology among women with EDs. These results underscore the potential value of incorporating gender-informed perspectives into future research and clinical reflection, while highlighting the need for replication in larger and longitudinally designed studies.

1. Introduction

Eating disorders (EDs) constitute a group of mental health conditions with complex and multifactorial etiology that predominantly affect adolescent girls and young women, representing a significant public health problem in developed countries [1]. According to the American Psychiatric Association [2], these disorders are characterized by persistent patterns of disturbed eating and dysfunctional behaviors related to food intake, such as extreme restriction, binge eating episodes, or compensatory behaviors, typically accompanied by intense concerns about body weight, body shape, or both. The high prevalence of EDs, together with the severity of their clinical manifestations and their frequently chronic course, leads to a significant deterioration in physical and mental health, along with psychosocial functioning in affected individuals [3,4].

Scientific evidence has consistently shown a higher prevalence of EDs in women compared to men, particularly during adolescence and early adulthood [5,6]. Traditionally, this disparity has been explained through biological and epidemiological factors; however, these approaches are insufficient to fully understand the observed differences in incidence, symptom expression, and clinical course of eating disorders. In this regard, several studies have highlighted the need to incorporate analyses of gender constructs and traditional roles as key elements in the etiology and manifestation of EDs [7,8]. Sociocultural pressures that associate thinness with femininity, self-control, and personal success create a normative context that promotes body dissatisfaction and the adoption of dysfunctional eating behaviors, particularly among women and girls [9,10].

From a gender-based health perspective, gender is conceived as a fundamental analytical category for understanding how roles, norms, and social expectations influence patterns of well-being, morbidity, and access to health resources [11]. Within this framework, gender is not understood as an individual attribute or a purely demographic variable, but as a sociocultural system that is enacted through gender norms and shared societal expectations regarding how women and men should think, feel, and behave by virtue of their gender. Following Mahalik and colleagues [12,13], gender norms are conceptualized as culturally embedded standards that prescribe acceptable and valued gendered behaviors, and whose internalization varies across individuals.

Accordingly, in this study, gender is operationalized through the assessment of conformity to traditional feminine gender norms, capturing the extent to which women endorse and adhere to normative expectations related to femininity (e.g., appearance, thinness, domesticity, or sexual fidelity). In the context of EDs, the conformity of traditional gender norms may directly influence body image perception, the internalization of normative aesthetic ideals, and the adoption of eating-related risk behaviors [14].

Empirical evidence has supported this relationship from the early stages of research. Classical studies, such as those by Murnen and Smolak [15] and Cantrell and Ellis [16], demonstrated that gender role-related identities are associated with differential risk patterns for the development of EDs. More recently, the meta-analysis conducted by Thapliyal, Hay, and Conti [17] concluded that the therapeutic experiences of women and men with eating disorders differ significantly according to their alignment with gender expectations, underscoring the importance of incorporating a gender-informed perspective in both research and clinical practice. Similarly, Griffiths and Yager [18] introduced the concept of gender embodiment, which describes how bodily experience and identity are shaped in relation to cultural norms of femininity and self-control.

In addition, current research agrees that gender socialization processes play a central role in the onset and maintenance of EDs. Cultural pressures regarding the female body, thinness ideals, and norms of bodily self-control have been identified as structural determinants that increase eating-related vulnerability among young women [19]. In this context, psychosocial factors such as body dissatisfaction, depression, and low self-esteem are more prevalent among adolescent girls and act as relevant precursors to eating disorders [3,20]. This vulnerability is intensified by the influence of mass media and social networks, which promote restrictive beauty ideals and reinforce the association between thinness, success, and social value [21,22]. The high prevalence of body dissatisfaction in this group has led to the description of this phenomenon as normative discontent, reflecting its normalization in adolescent female experience [23].

Despite this well-established theoretical framework, most studies on EDs have approached gender from descriptive or comparative perspectives, focusing on sex differences while neglecting the empirical measurement of gender constructs [14]. The incorporation of instruments to operationalize gender remains limited, although there are relevant precedents, such as the study by Zwetzig [24], which used the Conformity to Feminine Norms Inventory (CFNI) and the Bem Sex Role Inventory (BSRI) to analyze the relationship between conformity to traditional feminine norms and symptom severity. The findings showed that higher internalization of traditional femininity ideals was associated with greater symptom severity, demonstrating the usefulness of these tools for advancing the understanding of the role of gender in EDs.

The novelty of the present study lies in moving beyond the conventional, largely descriptive treatment of “gender” as a proxy for sex differences by empirically operationalizing a specific gender construct—conformity to traditional feminine norms—and examining its associations with eating disorder-related risk behaviors and health outcomes among women with EDs. While the previous literature has extensively documented the higher prevalence of EDs among females and has theorized relevant sociocultural mechanisms, comparatively few studies have incorporated validated instruments to quantify gender role conformity and examine its relationship with both physical and mental health indicators in clinical populations.

From a gender-based health perspective, and consistent with prior theoretical work conceptualizing gender as a key analytical category for understanding health-related inequalities [11], conformity to feminine norms is approached in this study as a gender-related psychosocial factor linked to patterns of vulnerability and well-being. Importantly, given the exploratory and cross-sectional nature of the present research and the characteristics of the clinical sample, these variables are examined as associative correlates rather than as empirical or population-level determinants of health.

In this context, the present study aims to explore how conformity to traditional feminine gender norms may relate to health outcomes among individuals presenting with eating disorder symptomatology. Specifically, we examine associations between conformity to feminine norms, physical and mental health indicators, and eating-related risk behaviors, in a heterogeneous clinical sample. This work is intended to provide preliminary, hypothesis-generating evidence to inform future research and clinical reflection from a gender perspective, while recognizing that diagnostic and stage-specific conclusions require replication in larger, stratified samples.

2. Method

2.1. Ethical Considerations

This study was conducted in accordance with the Declaration of Helsinki and with approval from the Ethics Committee of the University of Murcia (approval code: 1424/2016, date: 30 January 2017) as part of a broader health research project. All participants were adults (≥18 years) and provided written informed consent prior to participation. Participation was voluntary, and participants were informed of their right to withdraw at any time without consequence. Data were collected and stored anonymously, and confidentiality was ensured in accordance with applicable data protection regulations.

2.2. Participants

The sample was recruited through collaboration with two specialized clinic centers in eating disorders (EDs) from several outpatient and day-care centers in Madrid and Bilbao. Inclusion criteria were participants aged 14 years or older and currently receiving treatment after being diagnosed with an ED. Exclusion criterion included insufficient Spanish language proficiency and a lack of basic education necessary to complete the questionnaires.

The study included 40 women diagnosed with an ED according to Diagnostic and Statistical Manual of Mental Disorders Criteria (5th ed.) [2], who were receiving psychological treatment at one of the participating facilities. All participants were fully informed about the study by the project leaders and provided written informed consent for participation and inclusion of their data in the research. Participation was voluntary, and participants’ decision to participate or not participate had no impact on their treatment.

Participants’ ages ranged from 14 to 50 years, with a mean age of 23.30 years (SD = 9.52). The sample was heterogeneous in terms of ED diagnosis, Body Mass Index (BMI), illness duration, course, severity, educational attainment, and occupation. Diagnoses covered the full spectrum of EDs according to DSM-5-TR criteria [2].

Table 1. Sociodemographic and clinical variables (N = 40).

Variables	Values
Age (Mean/SD)	23.30/9.52
Civil status
Single	82.5%
Married	15%
Separated	2.5%
Educational attainment
Primary Education	25%
Secondary Education	20%
Post-secondary or tertiary education	55%
Occupation
Working	42.5%
Studying	50%
Unemployed	7.5%
Diagnosis	Current/initial
Anorexia	20%/40%
Bulimia	12.5%/30%
Obesity	15%/10%
EDNOS	52.5%/20%
Current course of illness
In partial remission	65%
In full remission	10%
Active symptomatology	20%
Other	5%
BMI (Mean/SD)	23.98/8.21
Duration of illness (Mean/SD)	9.21/8.53

Note: EDNOS = Eating disorder not otherwise specified; duration of illness (years).

shows this data alongside the initial and current diagnosis of each participant. It should be noted that differences between the initial and current diagnosis, so-called diagnostic migration, are relatively common in eating disorders, reflecting symptom fluctuation, partial remission or relapse, and treatment-related changes.

2.3. Procedure

This study is part of a broader investigation into reproductive health and employed a cross-sectional design, conducted in accordance with the STROBE Statement for reporting observational studies, enhancing transparency and methodological quality [25] (see Supplementary Materials).

The research protocol was preregistered in both English and Spanish on the Open Science Framework (OSF) “https://osf.io/572ek/overview?view_only=e1ed3450afb74ccbb668c8171785affe” (accessed on 15 December 2025 and was approved by the Ethics Committee of the University of Murcia (1424/2016)). All participants provided written informed consent and agreed to the publication of the data included in the manuscript. The study adhered to current legislation and followed the principles of the Declaration of Helsinki.

2.4. Measures

Assessment protocols were self-administered by participants, while clinical variables related to ED diagnosis were completed by the treating clinicians. The variables and instruments used were:

-

Sociodemographic Questionnaire. This questionnaire collected information on age, marital status, national origin, place of residence, educational attainment, and occupation.

-

Clinical Questionnaire. This questionnaire included variables related to illness onset, development, and course (i.e., diagnosis, current clinical status, and illness duration).

-

Self-Perceived Health. Adapted from the Spanish National Health Survey [25], this single-item measure assesses participants’ overall health status. Responses were rated on a 5-point Likert-type scale ranging from 1 (very poor) to 5 (very good).

-

Eating disorder symptomatology. In the present clinical sample, SCOFF Questionnaire scores were treated as a continuous indicator of eating disorder symptomatology. The SCOFF Questionnaire, Spanish adaptation by García-Campayo et al. [26], is a brief screening instrument originally developed by Morgan et al. (1999) for the early identification of eating disorders in clinical and research contexts [27]. It comprises five dichotomous items assessing core eating disorder symptomatology. A cut-off score of ≥2 indicates the presence of eating disorder risk behaviors. Reported sensitivity and specificity are high (sensitivity: 98%; specificity: 98% for bulimia nervosa, 93% for anorexia nervosa, and 100% for eating disorder not otherwise specified). In the present sample, internal consistency was α = 0.59.

-

Mental Health. Participants’ mental health status was assessed using the 12-item General Health Questionnaire (GHQ-12), Spanish adaptation by Sánchez-López and Dresch [28,29]. The GHQ-12 is a brief self-administered screening instrument for psychological distress. Higher scores indicate poorer mental health. Internal consistency in the present sample was excellent (α = 0.92).

-

Conformity to Feminine Gender Norms. Participants’ conformity to traditional feminine gender norms was assessed using the Conformity to Feminine Norms Inventory (CFNI) [13], adapted by Sánchez-López et al. [30]. The CFNI is a self-report measure designed to assess adherence to socially prescribed feminine norms and consists of 84 items rated on a 4-point Likert scale ranging from strongly disagree to strongly agree. The instrument assesses conformity across eight femininity subscales (see

Table 2. Description of the Conformity to Femininity Norms Inventory (CFNI) scales.

Subscale	Definition of Feminine Norm
Nice in relationships	Develop friendly and supportive relationships with others.
Care for children	Take care of and be with children.
Thinness	Pursue a thin body ideal.
Sexual fidelity	Keep sexual intimacy contained within one committed relationship.
Modesty	Refrain from calling attention to one’s talents or abilities.
Romantic relationship	Invest self in romantic relationship.
Domestic	Maintain the home.
Invest in appearance	Commit resources to maintaining and improving physical appearance.

Source: Elaborated by the authors on the basis of [13].

). In the present sample, internal consistency was satisfactory (Cronbach’s α = 0.82 for the total scale), with subscale reliability coefficients ranging from 0.72 to 0.91. In this study, the term feminine gender norms is used in an operational sense to refer to individual conformity to culturally prescribed feminine role expectations, as assessed by the CFNI. CFNI scores reflect the degree to which participants endorse and conform to specific feminine role prescriptions.

2.5. Data Analysis

Considering the exploratory nature of the study and the modest sample size, analyses were conducted with a hypothesis-generating aim. An a priori power analysis was conducted using G*Power version 3.1.7 [31] to estimate the sample size required to detect medium-to-large associations. Assuming a two-tailed correlation test (α = 0.05, 1 − β = 0.80) and an anticipated effect size of r = 0.43, the analysis indicated a required sample size of N = 40. This effect size corresponds to a medium-to-large association according to conventional benchmarks [4,32,33]. Accordingly, the results should be interpreted with the understanding that smaller effects may not have been detectable in the present sample.

Statistical analyses were conducted using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). Published data from the general Spanish population [25] were used as reference values for comparison.

Descriptive statistics were computed for all study variables. One-sample t tests were conducted to descriptively compare participants’ mental health (GHQ-12) and overall conformity to feminine gender norms (CFNI total score) with published Spanish normative values. Effect sizes were estimated using Cohen’s d, with values of 0.20, 0.50, and 0.80 indicating small, medium, and large effects, respectively [32,34].

Given the ordinal nature of some variables and the exploratory aim of the study, associations among eating disorder symptomatology (SCOFF), mental health (GHQ-12), self-perceived health, and conformity to feminine gender norms were examined using Spearman’s rho correlations. Exploratory correlations between eating disorder symptomatology and the eight CFNI dimensions were additionally examined. To control for multiple comparisons, a false discovery rate correction (Benjamini–Hochberg) was applied to these analyses.

Finally, a hierarchical linear regression analysis was conducted to examine the incremental contribution of conformity to feminine gender norms to eating disorder symptomatology. In the first step, health-related variables (mental health and self-perceived health) were entered into the model. In the second step, overall conformity to feminine gender norms (CFNI total score) was added to assess its additional contribution. Multicollinearity was assessed using tolerance and variance inflation factor (VIF) values, which were within acceptable limits for all predictors.

3. Results

The Results Section is organized into three subsections: First, participants’ sociodemographic and clinical characteristics are described, including normative comparisons on health-related and gender-related measures to contextualize the sample. Second, descriptive statistics and correlational analyses are presented to examine associations among the main study variables. Finally, a hierarchical regression analysis is reported to assess the incremental contribution of conformity to traditional gender norms to eating disorder symptomatology.

3.1. Participant Sociodemographic and Clinical Characteristics

Participant sociodemographic and clinical characteristics are described below, along with normative comparisons to contextualize the sample.

Table 1 displays the sociodemographic and clinical variables of the sample. The sample had a mean age of 23.30 years (SD = 9.52). Most participants were single (82.5%), followed by married (15%) and separated (2.5%). Regarding educational attainment, 25% reported primary education, 20% secondary education, and 55% post-secondary or tertiary education. In terms of occupation, 50% were studying, 42.5% were working, and 7.5% were unemployed.

For diagnosis, current/initial data comprised: anorexia (20%/40%), bulimia (12.5%/30%), obesity (15%/10%), and EDNOS (52.5%/20%). Concerning the current course of illness, 65% were in partial remission, 10% in full remission, 20% showed active symptomatology, and 5% were classified as others. Mean BMI was 23.98 (SD = 8.21), and mean duration of illness was 9.21 years (SD = 8.53).

The mean score on the GHQ-12 in the present sample was 14.10 (SD = 7.28), which was significantly higher—indicating poorer mental health—than that reported for the general Spanish population, t(39) = 4.17, p < 0.001, with a moderate-to-large and clinically meaningful effect size (d = 0.68).

Similarly, participants’ self-rated health was poorer than that observed in the general population. Only 37.5% of the sample reported good or very good physical health, compared with 70.2% of Spanish women aged 15 years and older, whereas 22.5% reported poor or very poor health, compared with approximately 6.9% in the general Spanish female population. Consistent with the aims of this study, these descriptive comparisons highlight the psychological vulnerability of the participants and provide an empirical context for examining how gender-related variables are associated with health status and eating disorder symptomatology.

To further characterize the sample in terms of gender-related variables, participants’ conformity to traditional feminine gender norms was assessed using the Conformity to Feminine Norms Inventory (CFNI). A one-sample t test showed that women in the present sample reported significantly higher overall conformity to feminine norms than published Spanish normative values (CFNI total score; M = 148.92, SD = 14.65), t(36) = 2.37, p < 0.01, with a small-to-moderate effect size (d = 0.38). Additional descriptive comparisons for the CFNI dimensions are reported in the Supplementary Table S1.

These comparisons are intended solely to provide descriptive context for the sample and do not imply representativeness or deviation from population norms.

3.2. Descriptive Statistics and Correlational Analyses

Descriptive statistics for all study variables are presented in

Table 3. Descriptive statistics for study variables.

Variable	N	M	SD	Min	Max
Body Mass Index (BMI)	40	23.98	8.21	15.62	47.43
Eating disorder symptomatology (SCOOF)	40	2.40	1.37	0	5
Mental Health (GHQ-12)	40	14.10	7.28	0	31
Self-Perceived Health	40	2.85	0.86	1	5
Feminine Gender Norms Conformity (CFNI)	37	148.92	14.65	123	182
CFNI 1. Nice in relationships	37	36.57	4.00	27	43
CFNI 2. Care for children	37	20.84	6.14	6	35
CFNI 3. Thinness	37	21.65	4.95	7	31
CFNI 4. Sexual fidelity	37	16.27	3.91	10	24
CFNI 5. Modesty	37	14.30	3.45	6	22
CFNI 6. Romantic relationship	37	11.49	3.37	7	19
CFNI 7. Domestic	37	14.65	2.35	10	19
CFNI 8. Invest in appearance	37	13.16	2.13	7	18

Note. Higher scores indicate greater eating disorder symptomatology, poorer mental health and self-perceived health, and stronger conformity to traditional gender norms. Due to missing data in the CFNI variables, sample size varies across analyses.

. Overall, no severe deviations from expected ranges were observed. Correlations among the main study variables are shown in

Table 4. Spearman correlations among main study variables.

Variable	1	2	3	4	5
IMC	—
1. Eating Disorder Risk (SCOOF)	0.19	—
2. Feminine Gender Norms Conformity (CFNI)	0.05	0.52 ***	—
3. Mental Health (GHQ-12)	0.13	0.52 ***	0.41 *	—
4. Self-Perceived Health	−0.12	0.46 **	0.10	0.32 *	—

Note. Spearman’s rho correlations are reported due to the ordinal nature of some study variables. Higher scores on mental and self-perceived health indicate poorer mental health and poorer perceived overall health status. * p < 0.05. ** p < 0.01. *** p < 0.001. N = 40 (pairwise deletion; CFNI variables N = 37).

. Given the ordinal nature of some variables and the exploratory aim of the study, Spearman’s rho correlations were computed and are interpreted descriptively.

Eating disorder risk was positively associated with poorer self-perceived health, poorer mental health and greater overall conformity to traditional gender norms.

Exploratory Spearman correlations were conducted to examine the associations between ED risk and the eight dimensions of conformity to traditional feminine gender norms (see Supplementary Table S1). Given the exploratory nature of these analyses and the number of comparisons performed, a false discovery rate correction (FDR; Benjamini–Hochberg) was applied. After correction, only two dimensions remained significantly associated with ED risk. Notably, conformity to thinness norms showed a strong positive association with ED risk, whereas the remaining dimensions were not significantly related. These findings suggest that specific aspects of gender norm conformity, particularly those related to body thinness ideals, may be more relevant to ED risk than conformity to traditional gender norms in general.

3.3. Hierarchical Regression Analysis

Subsequently, a hierarchical linear regression analysis was conducted to examine the incremental contribution of overall conformity to traditional gender norms to ED risk, after controlling for health-related variables. In the first step, mental health (GHQ total score) and self-perceived health were entered into the model. This model was statistically significant and explained 36.5% of the variance in ED risk (R² = 0.365, adjusted R² = 0.328), F (2, 34) = 9.79, p < 0.001.

In the second step, total conformity to traditional gender norms (CFNI total score) was added to the model. The inclusion of this variable resulted in a significant increase in explained variance (ΔR² = 0.095), F change (1, 33) = 5.85, p = 0.021, yielding a total R² of 0.461 (adjusted R² = 0.412). In the final model, poorer self-perceived health, poorer mental health, and greater conformity to traditional gender norms were all positively and significantly associated with ED risk. Regression coefficients for the final model are presented in

Table 5. Hierarchical linear regression predicting eating disorder risk (SCOFF).

Predictor	B	SE	β	t	p	95% CI for B
Model 1
Mental Health (GHQ-12)	0.078	0.028	0.408	2.79	0.009	[0.021, 0.135]
Self-Perceived Health	0.525	0.237	0.323	2.21	0.034	[0.042, 1.007]
Model 2
Mental Health (GHQ-12)	0.064	0.027	0.332	2.37	0.024	[0.009, 0.119]
Self-Perceived Health	0.559	0.223	0.345	2.51	0.017	[0.106, 1.012]
Feminine Gender Norms Conformity (CFNI)	0.030	0.013	0.317	2.42	0.021	[0.005, 0.056]

Note. Model 1: R² = 0.365, adjusted R² = 0.328. Model 2: R² = 0.461, adjusted R² = 0.412. ΔR² = 0.095, p = 0.021.

.

4. Discussion

The aim of the present study was to examine the relationship between conformity to traditional feminine gender norms, physical and mental health, and the presence of clinical indicators of eating disorders (EDs) in a clinical sample of women diagnosed with EDs. The findings provide additional evidence regarding the associations between gender norms and ED symptomatology and contribute new empirical insights into the potential role of gender-related psychosocial factors in women’s health. By explicitly measuring gender-related constructs, the study responds to current calls for a more nuanced operationalization of gender in mental health research.

Consistent with previous research, women in the present clinical sample reported significantly poorer mental health and self-perceived overall health reflecting the substantial psychological and somatic burden commonly associated with eating disorders. Previous studies have documented similar associations, showing links between EDs, anxiety, depression, and impaired well-being [3,4,35]. Likewise, Zeiler et al. [36], using the SCOFF questionnaire and measures of self-perceived health, found strong associations between disordered eating behaviors, general psychopathology, and reduced quality of life among adolescents. Recent research also documents substantial impairments in quality of life among individuals with EDs [6,19]. Taken together, these findings underscore the multifaceted nature of eating disorders and highlight the importance of holistic prevention and intervention approaches that address both physical and psychological dimensions of health and provide the necessary clinical context for examining the specific role of gender norms in shaping health outcomes.

With regard to conformity to traditional feminine gender norms, women in the present study showed higher overall conformity than women in the Spanish general population, particularly in norms related to thinness. These findings partially align with those reported by Mahalik et al. [13], who observed slightly higher conformity across a broader range of feminine norms among women with EDs. The discrepancies between studies may be explained by differences in sample characteristics. Specifically, the present study relied on a smaller convenience sample with a higher mean age, whereas Mahalik et al. [28] examined a younger and more culturally heterogeneous sample. These differences may influence the salience of certain gender norms across life stages and sociocultural contexts. In addition, in the present study, comparisons with general population reference values were included solely to provide descriptive context for the clinical profile of the sample and should not be interpreted as indicative of representativeness or deviation from normative standards.

Previous research has consistently shown that the internalization of sociocultural norms and engagement in social comparison processes are positively associated with eating disorder psychopathology [37]. Similarly, conformity to traditional gender roles, together with dominant beauty ideals and the cultural valorization of thinness, has been linked to the development of eating disorders such as anorexia nervosa and bulimia nervosa [38,39]. Recent reviews also emphasize the intensifying role of digital media and appearance-based evaluation in shaping body dissatisfaction and eating disorder risk [22,23]. Given the broad age range of the sample, age-related differences in sociocultural exposure may also be relevant. Younger participants may experience greater immersion in social media environments that amplify appearance-related pressures and reinforce unrealistic body ideals, potentially strengthening the internalization of thinness- and appearance-related gender expectations [40,41,42]. Conversely, older participants may have had more opportunities to develop coping strategies and resilience in response to gendered expectations and body-related sociocultural pressures, which could attenuate these associations [43,44]. Future studies should examine these possibilities using age-stratified designs and direct measures of social media exposure, social comparison, and coping processes, given the established links between social media-based social comparison, body image concerns, and eating disorder symptoms. In line with these findings, our results suggest that greater conformity to traditional gender norms may increase women’s vulnerability to eating disorders.

Higher conformity to feminine norms was associated with poorer mental health. At a more specific level, conformity to thinness norms was associated with greater eating disorder symptomatology. Taken together, these findings suggest that gendered expectations may be associated with poorer mental health and greater eating disorder symptomatology within the studied clinical sample of women. This set of findings align with prior research showing that conformity to traditional gender roles is associated with increased body dissatisfaction and the adoption of dysfunctional eating behaviors, particularly among women and girls [9,10], ultimately undermining psychological well-being [45,46].

Hierarchical regression analyses indicated that overall conformity to traditional feminine gender norms was associated with eating disorder symptomatology after accounting for health-related variables. The addition of gender norm conformity resulted in a modest but statistically significant increase in explained variance, suggesting that this construct may capture aspects of eating disorder vulnerability not fully accounted for by general indicators of mental health or self-perceived overall health. These findings should be interpreted cautiously. The regression analysis was conducted with an exploratory and hypothesis-generating aim, and the modest sample size and cross-sectional design preclude causal inferences or population-level conclusions. Nevertheless, the observed pattern of associations is consistent with calls for more integrated and gender-sensitive approaches to understanding eating disorders [7,14].

An additional contribution of this study lies in the explicit operationalization of gender as a measurable construct. Much of the existing literature on eating disorders has focused on documenting differences between women and men, often attributing these differences to “gender” without directly measuring gender-related variables. As a result, gender is frequently treated as an implicit explanatory factor rather than as an empirically testable dimension. By incorporating a validated measure of conformity to feminine gender norms, the present study moves beyond binary sex comparisons and allows for a more nuanced analysis of how internalized gender norms relate to health outcomes and risk behaviors associated with eating disorders. This approach aligns with calls to analytically distinguish between sex and gender and to conceptualize gender as a social determinant of health in general [11], and of eating disorder-related health in particular [7,14], rather than treating it merely as a demographic variable. Although the results suggest meaningful associations between conformity to feminine gender norms and eating-related risk behaviors, they should be interpreted in the context of the statistical uncertainty inherent to a modest sample size. This underscores the importance of replicating these findings in future studies with larger and more representative samples in order to confirm the robustness of the observed relationships.

Several limitations should be acknowledged. First, the study relied on a relatively small clinical convenience sample, reflecting the practical challenges of recruiting individuals with eating disorders. This modest sample size introduces statistical uncertainty and limits the generalizability of the findings beyond similar clinical contexts. In addition, although multiple correlational analyses were conducted, particular care was taken to mitigate the risk of Type I error. Specifically, the analytic strategy prioritized a small number of theoretically grounded focal variables, reduced emphasis on subscale-level findings, and applied a false discovery rate correction to exploratory analyses involving multiple comparisons. Nevertheless, given the exploratory nature of the study and the sample size, statistically significant associations should still be interpreted cautiously as preliminary and hypothesis-generating, pending replication in larger and adequately powered samples. Although an a priori power analysis supported the feasibility of detecting medium-to-large associations, future research using larger and more diverse samples will be necessary to obtain more precise and robust estimates of the relationships between conformity to feminine gender norms, health indicators, and eating disorder symptomatology.

Second, the heterogeneity of the clinical sample may have constrained the interpretability of the findings. Participants spanned a wide age range (14–50 years), presented with different eating disorder diagnoses (e.g., anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and obesity), and were at different stages of illness (active symptomatology, partial remission, and full remission). Although this heterogeneity allowed for an initial exploration of associations across diverse eating disorder presentations, it may also have obscured diagnosis- and stage-specific patterns. Developmental stage, diagnostic category, and illness course are likely to influence both the internalization of gender norms and the expression of eating disorder symptomatology [47,48]. In addition, gender role expectations and appearance-related sociocultural pressures may vary across cultural contexts, potentially shaping both conformity to feminine norms and eating disorder symptomatology, which may further limit the generalizability of the findings.

Third, the cross-sectional design of the study precludes causal inference and does not allow for the examination of clinically relevant longitudinal processes, such as illness duration, symptom progression, or recovery trajectories. These limitations underscore the exploratory and hypothesis-generating nature of the present findings and highlight the need for future research using longitudinal designs that are both diagnostically and developmentally stratified.

Fourth, although a hierarchical regression analysis was used to examine the incremental contribution of gender-related variables, these results should be interpreted cautiously. Given the modest sample size and the conceptual proximity of several predictors, the precision of the estimated effects is likely limited. Accordingly, the regression findings are best understood as illustrative of potential associative patterns rather than as providing robust estimates of effect size. Future studies with larger samples would allow for more parsimonious modeling strategies, the application of cross-validation approaches, and more reliable assessment of the stability and generalizability of these associations.

Finally, the use of the SCOFF questionnaire as a brief screening instrument did not allow for diagnostic confirmation or detailed differentiation between eating disorder subtypes. Its inclusion was nevertheless justified given the exploratory nature of the study, its brevity, extensive prior validation, and widespread use in both clinical and research contexts [49]. However, as noted in previous research, the SCOFF’s dichotomous self-report format may be susceptible to response biases and variable psychometric performance [50]. The modest internal consistency observed in the present sample therefore warrants cautious interpretation of findings involving this measure.

Despite these limitations, the present study makes a meaningful contribution by providing preliminary empirical evidence on the association between conformity to traditional feminine gender norms and outcomes related to eating disorders from a gender-sensitive perspective. By operationalizing gender norm conformity using a validated measure and examining its links with physical and mental health indicators as well as eating-related risk behaviors, this study helps to motivate more definitive research using adequately powered designs. Overall, the findings underscore the potential value of integrating gender-informed and empirically grounded frameworks into future research and clinical reflection in the field of eating disorders.

5. Conclusions

The present study provides preliminary empirical evidence of associations between conformity to traditional feminine gender norms and eating disorder-related outcomes among women diagnosed with eating disorders, based on a modest and heterogeneous clinical sample. Higher overall conformity to feminine norms was associated with poorer physical and mental health indicators and greater eating disorder symptomatology. Exploratory analyses further suggested that norms related to thinness and appearance may be particularly salient within this pattern of associations, although these findings should be interpreted cautiously.

Overall, these results are consistent with gender-sensitive theoretical models that emphasize the interplay between individual, psychosocial, and sociocultural factors in eating disorders. By moving beyond purely biomedical or symptom-focused perspectives, the present findings highlight the potential value of incorporating gender-informed frameworks that acknowledge the role of sociocultural norms in shaping women’s health experiences.

Importantly, the present results should be understood as exploratory and hypothesis-generating. While addressing the internalization of restrictive femininity norms may represent a promising complementary focus for prevention and intervention efforts, further research is required before clinical recommendations can be drawn. Future studies using larger, diagnostically and developmentally stratified samples and longitudinal designs will be essential to clarify the temporal and contextual mechanisms linking gender norms, health outcomes, and eating disorder symptomatology, thereby strengthening the empirical foundation for gender-informed research and clinical reflection.