Validation of the Brief Assessment of Stress and Eating (BASE) in transgender and gender-diverse adults

Objective: Eating disorders (EDs) are frequently underdiagnosed in transgender and gender-diverse (TGD) adults. Many existing ED screeners were developed in cisgender, White, female samples and may miss symptom patterns relevant to TGD adults. This study evaluated internal consistency and screening accuracy of the Brief Assessment of Stress and Eating (BASE), a 10-item ED screener, in a national sample of TGD adults. Method: Participants were 2098 TGD adults (57.5% gender diverse; 28.5% transgender men; 14.0% transgender women) enrolled in The PRIDE Study, a U.S.-based longitudinal cohort. Participants completed the BASE and SCOFF and were identified for elevated ED risk using a DSM-5–aligned Eating Disorder Diagnostic Scale algorithm. We examined internal consistency and classification accuracy using receiver operating characteristic and precision-recall curves, and compared BASE and SCOFF performance overall and by gender subgroup. Results: The BASE showed good internal consistency (ordinal α = 0.80). In the full sample, the BASE outperformed the SCOFF (AUC = 0.803 vs. 0.764, p = .0003), with a similar pattern among transgender men (AUC = 0.793 vs. 0.730). Among transgender women and gender-diverse adults, AUCs did not differ significantly between the BASE and SCOFF. Cut-scores based on Youden's J (7.5–8.5) produced balanced sensitivity (0.68–0.75) and specificity (0.70–0.77), whereas more liberal cut-scores (5–6) increased sensitivity (>0.85) with reduced specificity. Discussion: The BASE is a psychometrically sound and low-burden screener for elevated ED risk in TGD adults. Its broader symptom coverage and comparable performance across TGD subgroups support use in primary care and gender-affirming services to improve identification of probable EDs.