LGBTQ+ Asian Americans experience unique psychological health concerns at the intersection of multiple forms of marginalization. White supremacist, cisheteronormative, and colonial ideals and their structural and interpersonal manifestations may encourage family rejection of LGBTQ+ identities within Asian American family units. Family shame, conflicts in allegiances, and internalized anti-LGBTQ+ stigma were hypothesized as mediators in the association between family rejection and psychological distress and disordered eating. The current study examined family rejection and its impacts on psychological distress and disordered eating in a sample of LGBTQ+ Asian American adults (N = 155; MAge = 24.26; 30.3% Gender Diverse) using a cross-sectional survey design and path analysis. There was a significant serial mediation such that family rejection was positively associated with conflicts in allegiances, which was positively associated with familial shame, which was positively associated with psychological distress (B = .12, p = .01). The same serial mediation was nonsignificant for disordered eating (B = .04, p = .26). Results indicate the importance of considering conflicts in allegiances, family shame, and the interpersonal dynamics of LGBTQ+ Asian Americans in understanding experiences of psychological distress and disordered eating. Implications are drawn for further research, clinical work, and broader efforts addressing the larger sociocultural environment that encourages familial rejection of LGBTQ+ identity.