Background <p>Eating disorders (EDs) are associated with high heterogeneity of sexual dysfunction, but the underlying psychological mechanisms contributing to these difficulties have been poorly investigated. This study aimed to explore whether body trusting and need for approval, two core dimensions of ED psychopathology, are associated with differences in sexual desire across subgroups of women with EDs.</p> Methods <p>A cross-sectional study was conducted with 348 women diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED). Participants completed the Female Sexual Function Index, the Multidimensional Assessment of Interoceptive Awareness, and the Attachment Style Questionnaire. Mixture regression modeling was used to identify clusters based on the prediction of body trusting and need for approval on sexual desire. Multigroup structural equation modeling (SEM) was used to confirm the identified clusters.</p> Results <p>Two clusters emerged. Cluster 1 showed a negative association of both need for approval and body trusting with sexual desire. Cluster 2 showed the opposite pattern, with both predictors positively associated with sexual desire. SEM confirmed the differential predictive pathways for these psychological traits across clusters membership in predicting desire.</p> Conclusions <p>Women with EDs show opposite patterns of association between need for approval and body trusting with sexual desire. These findings suggest the utility of interventions targeting interoception and attachment-related features and highlight the importance of individualized approaches to promote sexual well-being in the treatment of EDs.</p>