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The Impact of Social Connectedness and Internalized Transphobic Stigma on Self-Esteem Among Transgender and Gender Non-Conforming Adults
Abstract
The transgender and gender non-conforming (TGNC) community continues to represent a notably marginalized population exposed to pervasive discrimination, microaggressions, and victimization. Congruent with Minority Stress Model, TGNC individuals persistently experience barriers to well-being in contemporary society; however, research uncovering resilience-based pathways to health among this population is sparse. This study aimed to explore the impact and interaction between internalized transphobic stigma and a potential buffer against minority stress, social connectedness, on the self-esteem of TGNC identified adults. Data were collected from 65 TGNC identified adults during a national transgender conference. Multiple regression analysis reveal that self-esteem is negatively impacted by internalized transphobia and positively impacted by social connectedness. Social connectedness did not significantly moderate the relationship between internalized transphobia and self-esteem. Micro and macro interventions aimed at increasing social connectedness and decreasing internalized transphobic stigma may be paramount for enhancing resiliency and well-being among the TGNC community.
... Numerous researchers have written about the impact of such experiences on transgender and gender-nonconforming persons, 2 reporting that these experiences often lead to increased depression (Brennan et al., 2017;DeVylder et al., 2017;Puckett et al., 2020), elevated levels of anxiety (Brennan et al., 2017;Puckett et al., 2020), reduced self-esteem (Austin & Goodman, 2017;Doyle et al., 2021), diminished life satisfaction (Doyle et al., 2021), and poorer body image (Tabaac et al., 2018). Anti-transgender discrimination, harassment, and/or violence have also been linked with behavioral outcomes such as suicidal attempts (Beckwith et al., 2019;Mak et al., 2020) and substance misuse (Wolfe et al., 2021;Wolford-Clevenger et al., 2021). ...
... With respect to the present study's discovery that the more different types of anti-transgender discrimination, harassment, and/or violence that people experienced, the more likely they were to experience serious psychological distress AND to contemplate suicide AND to misuse one or more substances, other researchers as well have reported that antitransgender experiences lead to a variety of adverse outcomes among transgender persons. Included among these are psychosocial outcomes such as lower self-esteem (Austin & Goodman, 2017;Taylor et al., 2022), greater post-traumatic stress Sherman et al., 2020;Valentine et al., 2023), higher rates of depression Puckett et al., 2020;Sherman et al., 2020), increased sense of hopelessness (Tebbe et al., 2022), higher rates of suicidal ideation (Brennan et al., 2017), and higher rates of anxiety Puckett et al., 2020) as well as behavioral outcomes such as higher rates of substance use/misuse (Kidd et al., 2021;Wolfe et al., 2021;Wolford-Clevenger et al., 2021) and a greater propensity toward attempting suicide (Meza-Lazaro & Bacio, 2021;Romanelli et al., 2018;Trujillo et al., 2017). The present study's finding with regard to anti-transgender experiences being a risk factor for experiencing the "triple whammy" is consistent with this body of literature. ...
... Transgender congruence is the degree to which transgender individuals feel genuine, authentic, and comfortable within their external appearance and presence and accept their real identity rather than the socially prescribed identity (Kozee et al., 2012]. A sense of congruence is essential to the functioning and mental wellbeing of transgender and gender nonconforming (TGNC) people, particularly body satisfaction, sexual satisfaction, and self-esteem (Austin & Goodman, 2016;Jones et al., 2019;Martin, 2020]. This statement is further supported by Owen-Smith and colleagues' (2018) findings, wherein the post-stages of gender-confirming treatments exhibit a decline in distress levels for patients who underwent them. ...
... However, phase 1 results of the study showed no significant relationship between transgender congruence and QOL among Trans Pinoys and Trans Pinays, and transgender congruence did not significantly predict their quality of life. This result is in contrast with studies stating that gender incongruence negatively impacts an individual's quality of life and that a sense of congruence is essential to the functioning and mental well-being of transgender individuals (Austin & Goodman, 2016;Huit et al., 2021;Jellestad et al., 2018;Jones et al., 2019;Kozee et al., 2012;Martin, 2020;Owen-Smith et al., 2018;Van Den Brink et al., 2020;Velez et al., 2016). The contrast between previous studies' results and our findings may be attributed to cultural values and norms. ...
Quality of life is a broad multidimensional concept containing negative and positive aspects of life. For transgender individuals, significant challenges through a mass of internal and external factors impact their general view of their status in life. Moreover, transgender congruence, which is to feel authentic towards one’s inner and outward expressions of the self and genuine identity rather than that which is socially dictated, is essential for trans individuals. This study’s mixed-method sequential explanatory approach investigated transgender congruence and quality of life among selected transgender individuals of Filipino descent. A sample of 125 Trans Pinoys and Trans Pinays, ages 18 to 64, participated in Phase I, a predictive, cross-sectional design wherein participants completed the Transgender Congruence Scale and the Quality of Life Scale. Phase II, a phenomenological approach, further explained the results of Phase I among 10 trans participants. Quantitative results revealed that transgender congruence does not predict the quality of life among trans-Filipinos. Qualitative findings identified four themes (Social Support, Realizing Gender Identity, Authenticity & Self-Perception, and Challenges to Transitioning) as significantly impacting the quality of life among transgender individuals of Filipino descent in our study other than transgender congruence.
... They also had an additional indirect effect on suicidal ideation through their impact on level of psychological distress (i.e., anti-transgender experiences → psychological distress → suicidal ideation). Numerous researchers have spoken about the impact of anti-transgender discrimination, harassment, and/or violence on transgender and gender-nonconforming persons, reporting that these experiences often lead to increased depression (Brennan et al., 2017;DeVylder et al., 2017;Puckett et al., 2020), elevated levels of anxiety (Brennan et al., 2017;Puckett et al., 2020), reduced self-esteem (Austin & Goodman, 2017;Doyle et al., 2021), diminished life satisfaction (Doyle et al., 2021), and poorer body image (Tabaac et al., 2018). The present study is consistent with these findings and demonstrates yet another harmful series of results emanating from experiencing transgenderrelated discrimination, harassment, and violence-namely, an increased likelihood of engaging in sex trading behaviors, an elevated risk of experiencing psychological distress, and a heightened risk of contemplating suicide. ...
... They also had an additional indirect effect on suicidal ideation through their impact on level of psychological distress (i.e., anti-transgender experiences → psychological distress → suicidal ideation). Numerous researchers have spoken about the impact of anti-transgender discrimination, harassment, and/or violence on transgender and gender-nonconforming persons, reporting that these experiences often lead to increased depression (Brennan et al., 2017;DeVylder et al., 2017;Puckett et al., 2020), elevated levels of anxiety (Brennan et al., 2017;Puckett et al., 2020), reduced self-esteem (Austin & Goodman, 2017;Doyle et al., 2021), diminished life satisfaction (Doyle et al., 2021), and poorer body image (Tabaac et al., 2018). The present study is consistent with these findings and demonstrates yet another harmful series of results emanating from experiencing transgenderrelated discrimination, harassment, and violence-namely, an increased likelihood of engaging in sex trading behaviors, an elevated risk of experiencing psychological distress, and a heightened risk of contemplating suicide. ...
Very little research has been undertaken to examine the prevalence of sex-trading behaviors among transgender adults, and even less is known about how engaging in this behavior affects sex-trading individuals. This paper examines the nexus of sex trading and psychological distress and suicidal ideation. Data from the 2015 U.S. National Transgender Survey were used to examine the factors associated with sex trading in a sample of 27,715 transgender Americans aged 18 or older. The Kessler-6 scale was used to measure psychological distress and a dichotomous measure of suicidal ideation during the past year was the other main outcome measure. Covariates in the multivariate analysis included sociodemographic measures, numerous measures of anti-transgender harassment, discrimination, and violence, and several transition milestones. Approximately one person in six had engaged in sex-trading behaviors. Multivariate analysis revealed that sex trading was related to psychological distress and to an increased risk of suicidal ideation. Structural equation analysis showed that sex trading had both a direct impact upon suicidal ideation and an indirect effect through its influence on psychological distress, which was the strongest predictor of suicidal ideation. Although sex trading is relatively uncommon among transgender persons, it is much more common in this population than it is in the population-at-large. Among persons who engage in this practice, though, there is a greatly elevated risk for suffering from psychological distress and suicidal ideation.
... Since 1975, investigations into the Clubhouse model have yielded support for processes now described as social practice-specifically, processes intended to promote recovery through social integration and connectedness [3,63,64]. Extending beyond the realm of recovery from SMI, social connection and integration is strongly linked with lower levels of depression and anxiety [65][66][67], higher self-esteem [68,69], and many aspects of biological wellbeing, including HPA-axis regulation [70], immune function [71], and overall mortality risk [72]. Studies across a variety of related fields have sought to elucidate the mechanisms of these relationships; for instance, research stemming from polyvagal theory suggests that the autonomic nervous system responds subconsciously to social safety cues, by way of the ventral vagus nerve [73]. ...
Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model’s cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015–2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term “Clubhouse,” 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery—aims that may yield implications beyond the realm of serious mental illness.
... Further, though the impact of these social and economic stressors on adverse physical and mental health outcomes has been well-established in the literature (Adler & Stewart, 2010;Braveman, Egerter, & Williams, 2011;Marmot & Bell, 2012), most healthcare systems do not screen for these stressors and patients' broader lived experience is rarely addressed in addictions and/or other behavioral interventions in clinical settings. Interventions that address the lived experiences of persons with addictions are in their nascence and should be further developed and tested (Tsui et al., 2021), particularly for transgender individuals (Austin & Goodman, 2017;Blosnich et al., 2013;Blosnich, Lehavot, et al., 2017;Brown & Jones, 2016;Glick et al., 2018;Hatzenbuehler et al., 2013;Hatzenbuehler & Pachankis, 2016;Lehavot & Simoni, 2011). ...
... While individuals in transition may access support from other gender minority people, the longevity of relationships pre-transition is often compromised and can contribute to greater internalized transphobia. Recent research suggests that while social connectedness is significantly and positively associated with self-esteem among GM adults, the strength of the association between IT and low self-esteem remains (Austin & Goodman, 2017). It appears that social support does not provide a viable buffer against the insidious nature of internalized transphobia. ...
Adverse Childhood Experiences and Intimate Partner Violence in Gender Minority Populations - Claire Mason McCown, M.P.S.
Childhood adversity has been linked to numerous health and mental health concerns in adulthood (Felitti et al., 1998). Among the many outcomes associated with adverse childhood experiences (ACEs), victimization and perpetration of intimate partner violence (IPV) remains a public health crisis. Research has found that those identifying as gender minority individuals are disproportionately impacted by IPV (Messinger, 2017; Peitzmeier et al., 2020). Further, gender minority individuals experience equivalent, if not higher, rates of ACEs when compared to their cisgender counterparts (Baams, 2018; Juárez-Chávez et al., 2018; Schnarrs et al., 2019; Tobin & Delaney, 2019). While many factors contribute to the pathway from ACEs to IPV, the role of internalized transphobia (IT) in this relation is poorly understood. However, previous research has underscored the role of internalized shame in relation to both ACEs and IPV (Rood et al., 2017; Thaggard & Montayre, 2019; Thomson & Jaque, 2018b). Internalized transphobia may therefore serve as a mediator in the relationship between adverse childhood experiences and intimate partner violence. Using a cross-sectional quantitative single administration survey design, this research aimed to better understand the relation between ACEs, IT, and IPV in adults identifying as gender minorities. This study used a mediated regression model to discern if internalized transphobia mediated the relationship between childhood adversity and intimate partner violence. Findings from this research indicated that while internalized transphobia did not mediate the relationship between ACEs and IPV, IT was still predictive of IPV. Endorsement of ACEs also predicted endorsement of IPV.
Keywords: Gender Minority, Adverse Childhood Experiences, Intimate Partner Violence
Neuropsychological assessments can have marked impacts on individuals because outcomes directly inform interventions, medication management, and accommodation services. Higher level psychological assessments have a tremendous amount of empirical backing and standardized norms; however, they often rely on gender-based norms, resulting in problems with translating findings to nonbinary examinees. Research and guidance are currently lacking on how to translate binary gender-normed assessments to be inclusive of transgender and gender diverse clients. Until more inclusive assessments are extensively studied and normed, clinicians need a process to use current materials while incorporating diversity, equity, and inclusion. The following includes recommendations for creating a trans-affirmative assessment practice, including measure selection and interpretation and how to provide gender diverse clients with a respectful and supportive assessment environment.
The present study was conducted to investigate the relationship between self-objectification, internalized transphobia, and psychological distress in male-to-female (MtF) transgenders. It was hypothesized that: 1) there would be a positive relationship between self-objectification, internalized transphobia, and psychological distress in male-to-female (MtF) transgenders; and 2) Self-objectification and internalized transphobia would predict the psychological distress in MtF transgenders. A correlational research design was used. A sample comprising of 136 MtF transgenders with an age range of 19-55 years (M = 34.46, SD = 9.09) were approached by employing purposive sampling technique. Data were collected from Fountain House and the Khawaja Sira Society of Lahore. A self-constructed demographic information sheet, Urdu versions of Self-objectification Questionnaire, Transgender Identity Scale, and the Depression Anxiety Stress Scale-21 (DASS-21) were used for assessment. The results exhibited a positive relationship between self-objectification, internalized transphobia, and psychological distress in MtF transgenders. Furthermore, the results also displayed that self-objectification and pride and shame related internalized transphobia positively predicted the psychological distress in MtF transgenders. This study will contribute towards the development of program that will ensure lesser distress and improved quality life for the transgender communities.
Social work has professional and academic standards consistent with transgender affirmative education and practice. Nevertheless, a growing body of research suggests that transgender issues are largely absent from social work education, resulting in practitioners who are uninformed or biased against transgender issues. The present study expands the literature through a mixed methods study exploring perceptions of transgender issues in social work education from the perspectives of transgender social work students (n = 97). Quantitative and qualitative analyses reveal barriers to transgender affirmative social work education including (1) transphobic microaggressions within classroom and field settings, (2) the absence of transgender specific education and expertise, and (3) the general lack of visibility of transgender issues. Recommendations for transgender affirmative social work education are provided.
This chapter describes the qualitative analysis of responses given by 122 transgender persons aged 61 and older who answered nine questions in an online survey about hopes and fears about aging, strategies for successful aging, and wisdom to convey to younger transgender individuals. More than 70 % stated they believe they are aging successfully. We identified six components of the resilience repertoires that enabled them to say they are aging successfully despite the stigma associated with their gender-variant identities and sexual minority status. Queer theory and the idea of intersectionality contributed to our interpretation of the resilience repertoires.
The primary aim of the present study is to extend discussions of navigating an emerging transgender or gender nonconforming (TGNC) identity during youth and young adulthood in a society in which TGNC identities remain invisible and marginalized. Participants include 13 racially/ethnically diverse TGNC young adults ages 18–29 in the United States. Constructivist grounded theory methods were used to collect, analyze, and interpret data. Navigating a TGNC Identity in the Dark emerged as a journey from initial recognition of an existing, but unidentifiable, difference toward awareness and acceptance of a TGNC identity. Analyses revealed six themes associated with navigating identity: Moving from Uncertainty to Knowing, Recognizing Self in Others, Finding Me, Explaining Work, Struggling for Authenticity, and Evolving Self-Acceptance. Narratives highlighted the complex journeys toward authenticity that included pervasive oppression. Findings from my study can be used to inform clinical work aimed at supporting TGNC individuals as they recognize and make meaning of their TGNC identities. Moreover, findings underscore the importance of increasing the level of visibility and affirmation of a range of TGNC identities and experiences in dominant institutions (e.g., media, schools, health care) in the lives of youth as a way to facilitate self-understanding and acceptance at earlier ages and with fewer obstacles.
This study examined transgender community belongingness as a mediator between strength of transgender identity and well-being. A total of 571 transgender adults (n = 209 transgender women, n = 217 transgender men, and n = 145 nonbinary-identified individuals) completed an online survey assessing transgender community belongingness, strength of transgender identity (operationalized as the extent to which a person self-categorizes their identity as transgender and the extent to which they believe their gender transition to be important to their self-definition), and well-being (using measures of self-esteem, satisfaction with life, and psychological well-being). Structural equation modeling was used to analyze the data. When controlling for participants' income, age, and stage of gender transition, transgender community belongingness fully mediated the relationship between strength of transgender identity and well-being. Strength of transgender identity was indirectly and positively related to well-being through community belongingness, but was not directly related to well-being. Results suggest that transgender community belongingness is an important construct in the mental health of transgender people. The strength of a person's transgender identity also appears to be a significant construct in transgender people's well-being via its relationship with transgender community belongingness. Implications of the findings are discussed. (PsycINFO Database Record
For those identifying as transgender or gender nonconforming (TGNC), the support of others can be instrumental in mitigating the challenges associated with cross-gender transition and identification. Social support and connectedness to the TGNC community can positively impact psychological well-being, facilitate resilience, and buffer against external stigmatization, prejudice, and discrimination (Frost & Meyer, 2012; Hendricks & Testa, 2012). The present study seeks to improve understanding of relationships among general social support (GSS), trans community connectedness (TCC), depressive symptoms, and anxiety symptoms. The inclusion of 2 forms of social support allows for greater examination of the differential impact of perceived general support (i.e., from both cisgender and TGNC friends and family members) and TGNC-specific social support (i.e., feeling connected to other TGNC people). To honor the diversity within the TGNC community, the impact of social support was examined among TGNC participants differentiated by gender identity, ethnicity, and living environment. As part of the Internet-based Trans Health Survey, standardized measures of depression, generalized anxiety, and social support were administered to 865 TGNC adults. For both trans male spectrum (TMS) and trans female spectrum (TFS) participants, general social support was significantly negatively associated with symptoms of anxiety and depression. However, the negative correlation between trans community connectedness and mental health symptoms was significant only for TFS participants. Variations in perceived TCC among ethnicity and living environment groups--distinguished by gender identity--are also explored. Finally, targets for future minority stress and social support research with the TGNC population are discussed. Language: en
In 2015, the American Psychological Association adopted Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients in order to describe affirmative psychological practice with transgender and gender nonconforming (TGNC) clients. There are 16 guidelines in this document that guide TGNC-affirmative psychological practice across the lifespan, from TGNC children to older adults. The Guidelines are organized into five clusters: (a) foundational knowledge and awareness; (b) stigma, discrimination, and barriers to care; (c) lifespan development; (d) assessment, therapy, and intervention; and (e) research, education, and training. In addition, the guidelines provide attention to TGNC people across a range of gender and racial/ethnic identities. The psychological practice guidelines also attend to issues of research and how psychologists may address the many social inequities TGNC people experience.
Research examining risk and resilience among transgender individuals suggests that connection to a transgender community may be protective. Utilizing archival survey data of 3,087 adult transgender participants collected in 2005–06, this study further evaluated how awareness and engagement with other transgender people influences risk and resilience during early gender identity development. As hypothesized, among male-to-female and female-to-male respondents, both prior awareness and prior engagement with other transgender people were independently related to less fearfulness, less suicidality, and more comfort. These relationships were not significant among male-to-different-gender or female-to-different-gender participants. Implications of these findings are discussed.