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Help-Seeking Barriers Among Sexual and Gender Minority Individuals Who Experience Intimate Partner Violence Victimization

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Abstract

Sexual and gender minority (SGM) individuals experience intimate partner violence (IPV) victimization at disproportionate rates compared to cisgender and heterosexual individuals. Given the widespread consequences of experiencing IPV victimization, intervention and prevention strategies should identify readily accessible and culturally competent services for this population. SGM individuals who experience IPV victimization face unique individual-, interpersonal-, and systemic-level barriers to accessing informal and formal support services needed to recover from IPV. This chapter reviews IPV victimization prevalence rates among SGM individuals in the context of minority stress and highlights unique forms of IPV victimization affecting this population, namely identity abuse. The literature on help-seeking processes among IPV survivors in general and help-seeking patterns and barriers specifically among SGM individuals who experience IPV victimization in the context of minority stress (e.g., discrimination, internalized stigma, rejection sensitivity, identity concealment) are discussed. How minority stressors at individual, interpersonal, and structural levels act as barriers to help-seeking among SGM individuals experiencing IPV victimization is presented. The chapter concludes with a review of emerging evidence for interventions aimed at reducing help-seeking barriers among SGM individuals who face IPV victimization and a discussion of future directions for research on help-seeking barriers in this population.
Chapter 8
Help-Seeking Barriers Among Sexual
and Gender Minority Individuals Who
Experience Intimate Partner Violence
Victimization
Jillian R. Scheer, Alexa Martin-Storey, and Laura Baams
Sexual and gender minority (SGM) individuals (e.g., those who may identify their
sexual orientation as lesbian, gay, bisexual, pansexual, or queer, and their gender
identity as transgender or gender nonbinary) disproportionately experience poten-
tially traumatic events compared to heterosexual and cisgender (non-transgender)
individuals (Alessi et al. 2013; Brown and Pantalone 2011; Katz-Wise and Hyde
2012; Roberts et al. 2010). Intimate partner violence (IPV) victimization refers to
the systemic use of physical, sexual, emotional, psychological, and economic abuse
with the intent to harm, threaten, control, isolate, restrain, or monitor another per-
son in an intimate partnership or dating relationship (Jewkes 2002; Sullivan 2019).
Notably, IPV represents one of the most common forms of interpersonal violence
faced by SGM individuals compared to hate crimes, childhood abuse, and non-partner
physical abuse (Brown and Herman 2015; Roberts et al. 2010). Despite SGM individ-
uals’ heightened risk of IPV victimization, the feminist paradigm’s exclusive focus
on IPV victimization among cisgender, heterosexual women perpetuate heteronor-
mative biases and fails to accurately capture IPV among SGM people (Brown and
Herman 2015; Langenderfer-Magruder et al. 2016).
J. R. Scheer (B
)
Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University,
135 College Street, New Haven, CT 06510, USA
e-mail: jillian.scheer@yale.edu
A. Martin-Storey
Department of Psychoéducation, Université de Sherbrooke, 2500 Boul. de l’Université, Pavillon
A7, Sherbrooke, QC J1K 2R1, Canada
e-mail: alexa.martin@usherbrooke.ca
L. Baams
Department of Pedagogy and Educational Sciences, University of Groningen, Grote Rozenstraat
38, 9712 TJ Groningen, The Netherlands
e-mail: L.Baams@rug.nl
© Springer Nature Switzerland AG 2020
B. Russell (ed.), Intimate Partner Violence and the LGBT+ Community,
https://doi.org/10.1007/978-3- 030-44762- 5_8
139
140 J. R. Scheer et al.
Consistent evidence demonstrates mental and physical health consequences
of IPV among SGM youth and adults including posttraumatic stress disorder,
depression, anxiety, substance use, chronic health conditions, HIV, and suicidality
(Bostwick et al. 2010; Miller et al. 2016; Scheer and Mereish in press; Woulfe
and Goodman 2019). Moreover, mental and physical health consequences of IPV
victimization are amplified for racial and ethnic minority SGM individuals, given
their experiences of multiple interlocking systems of oppression (i.e., racism,
sexism, homophobia, transphobia; Grant et al. 2011; Miller et al. 2016). In addi-
tion, psychosocial risk factors for experiencing IPV victimization among SGM
individuals include lower socioeconomic status, younger age, substance use, low
self-esteem, risky sexual behavior, HIV positive status, childhood abuse, and a
history of sex work and incarceration (Finneran and Stephenson 2013).
Social support networks and formal services reflect critical components to improv-
ing the mental health and safety of IPV survivors (Coker et al. 2002). Given the
widespread health consequences of experiencing IPV victimization among SGM
individuals, intervention and prevention strategies should identify readily accessible
and culturally competent services for this population (Calton et al. 2016). Never-
theless, SGM individuals experiencing IPV victimization face unique individual-,
interpersonal-, and systemic-level barriers to accessing informal and formal support
services needed to recover from abuse (Edwards et al. 2015; Helfrich and Simpson
2006).
In this chapter, we provide an overview of IPV victimization prevalence rates
among SGM individuals in the context of the minority stress framework and high-
light unique forms of IPV victimization affecting this population, namely identity
abuse. We review the literature on help-seeking processes among IPV survivors
in general and discuss help-seeking patterns specifically among SGM individuals
who experience IPV victimization. Next, we highlight SGM individuals’ IPV-related
help-seeking barriers in the context of minority stressors (e.g., discrimination, inter-
nalized stigma, rejection sensitivity, concealment). We cover empirical evidence on
the minority stressors at individual, interpersonal, and structural levels that act as
barriers to help-seeking among SGM individuals who experience IPV victimization.
Finally, we review emerging evidence for interventions aimed to reduce help-seeking
barriers among SGM individuals experiencing IPV victimization and conclude with
a discussion of future research directions on help-seeking barriers in this population.
IPV Victimization Prevalence Among SGM Individuals
Documenting the prevalence of IPV victimization experiences among SGM indi-
viduals is necessary to advancing knowledge of how best to serve and support this
population. Epidemiological research suggests that SGM individuals experience IPV
victimization at higher rates compared to cisgender, heterosexual individuals (Cen-
ters for Disease Control and Prevention [CDC] 2010). According to the National
Intimate Partner and Sexual Violence Survey, bisexual (61%) and lesbian women
8 Help-Seeking Barriers Among Sexual and Gender … 141
(44%) reported experiencing IPV victimization compared to 35% of heterosexual
women (Walters et al. 2013). In addition, 63% of gay and bisexual men, compared
with 29% of heterosexual men, reported experiencing IPV victimization (Walters
et al. 2013). Further, sexual minority women assigned female at birth are at height-
ened risk for experiencing sexual IPV victimization compared to sexual minority
men and heterosexual men and women (Messinger 2011; Whitton et al. 2019). Find-
ings also suggest that sexual minority youth are at an increased risk of experiencing
IPV victimization compared to cisgender, heterosexual youth (Edwards et al. 2015;
Martin-Storey 2015). One study found that sexual minority youth reported physical
IPV victimization (43.0%), psychological IPV victimization (59.0%), and sexual
IPV victimization (23.0%) at greater rates than heterosexual youth, who reported
rates of 29.0%, 46.0%, and 12.0% for IPV, respectively (Dank et al. 2014).
Determining accurate estimates of IPV victimization among gender minority pop-
ulations remains difficult due to a lack of studies with representative samples. In
fact, excluding gender minority individuals from IPV research maintains a tradi-
tional gender-based heterosexual model of IPV (Goldenberg et al. 2018). Among
the few studies that exist, results from the U.S. Trans Survey using a nonprobability
sample of 27,715 gender minority individuals demonstrate that 35% reported phys-
ical abuse and 16% reported sexual abuse by a partner (James, et al. 2016). Further,
some research suggests that gender minority individuals, regardless of sexual iden-
tity, report more physical IPV victimization compared to cisgender sexual minority
and cisgender heterosexual individuals (35% vs. 14% and 12%, respectively; Landers
and Gilsanz 2009).
SGM IPV in the Context of Minority Stress
In addition to risk factors that contribute to IPV among cisgender heterosexual indi-
viduals (e.g., alcohol abuse, childhood exposure to IPV; Balsam and Szymanski
2005), SGM individuals face additional stressors related to their stigmatized identities
(i.e., minority stress; Meyer 2003) that may further elevate their IPV risk (Balsam and
Szymanski 2005). According to the minority stress theory (Meyer 2003), commonly
identified health disparities observed between sexual minority and heterosexual pop-
ulations can be explained via the stigma associated with sexual minority status and
the resulting higher levels of discrimination, internalized heterosexism, anticipation
of discrimination, and identity concealment. While initially developed to contextual-
ize vulnerabilities among sexual minority populations, this theory also helps to frame
gender minority individuals’ elevated health risks compared to cisgender individuals
(Testa et al. 2015; Timmins et al. 2017). One central tenet of the minority stress
theory reflects that SGM individuals experience higher levels of stress at individual,
interpersonal, and structural levels deriving from their marginalized social status
(Meyer 2003). Further, Meyer (2003) conceptualized minority stressors as: (1) addi-
tive to general stressors that the general population experience; (2) chronic, as they
relate to stable social structures; and, (3) socially based rather than stemming from
142 J. R. Scheer et al.
isolated events or people (Hatzenbuehler and Pachankis 2016). In this chapter, we
utilize the minority stress framework to contextualize help-seeking barriers among
SGM populations who face IPV victimization.
Identity Abuse as a Form of IPV Victimization
For SGM individuals, IPV victimization occurs within a larger societal and systemic
context of heterosexism (i.e., a system that privileges heterosexual individuals) and
cissexism (i.e., a system that results in disadvantages for gender minority individuals;
Katz-Wise and Hyde 2012; Scheer and Baams 2019). Along with more traditional
forms of IPV, intrapsychic, interpersonal, and structural forms of stigma can be used
as tactics of control against SGM people (Balsam and Szymanski 2005; Guadalupe-
Diaz and Anthony 2017; Miller et al. 2016; Scheer et al. 2019; Woulfe and Goodman
2018; Woulfe and Goodman 2019). This IPV dynamic is known as identity abuse, or
the targeting, discrediting, belittling, and devaluing of a partner’s already-stigmatized
SGM identity (Guadalupe-Diaz and Anthony 2017; Scheer et al. 2019; Woulfe and
Goodman 2018). Identity abuse contains four broad domains: (a) disclosing a part-
ner’s SGM status to others such as family members or an employer without the
partner’s consent; (b) undermining, attacking, or denying a partner’s SGM status;
(c) using slurs or derogatory language regarding a partner’s SGM status; and, (d)
isolating a partner from SGM communities (Guadalupe-Diaz and Anthony 2017;
Woulfe and Goodman 2018).
Few studies have formally examined prevalence estimates of identity abuse vic-
timization among SGM individuals, because until recently, no formal measure existed
to assess for SGM-specific identity abuse (Scheer et al. 2019; Woulfe and Goodman
2018). Within SGM populations, emerging findings suggest that gender minority
individuals may be uniquely affected by identity abuse compared to sexual minority
individuals given their differentially stigmatized status relative to their sexual minor-
ity counterparts (Scheer and Baams 2019; Woulfe and Goodman 2018). Additional
research is needed to uncover the ways in which transphobia is used and experienced
as a tactic of power and control among gender minority individuals.
Health Consequences of Experiencing IPV Victimization
IPV victimization experiences represent a key driver of SGM health disparities (e.g.,
suicidality, substance use, depression; Walters et al. 2013). Notably, sexual minority
men and transgender individuals who experience IPV victimization are at heightened
risk of HIV transmission, attributable to trouble negotiating safer sex practices due
to a decreased perception of control over sex and fear of IPV (Heintz and Melendez
2006). In addition, identity abuse victimization is associated with depression and
posttraumatic stress disorder above and beyond the effects of psychological and
8 Help-Seeking Barriers Among Sexual and Gender … 143
physical forms of IPV victimization among SGM individuals (Woulfe and Goodman
2019). Emotional and tangible support from informal or formal avenues can protect
against the deleterious health impact of IPV victimization (Liang et al. 2005). While
it is critical for SGM individuals who experience IPV victimization to report IPV
and seek assistance without fear of harm, rejection, or criminalization (Ford et al.
2013), this population faces significant help-seeking barriers directly related to their
stigmatized social status (Calton et al. 2016). The next section discusses general IPV-
related help-seeking processes and reviews the literature on help-seeking patterns and
barriers among SGM individuals who experience IPV victimization.
Help-Seeking Processes Among Individuals Who Experience
IPV Victimization
Help seeking among individuals who experience IPV victimization represents as a
multistage process that involves: (1) recognizing and defining the abusive situation as
unmanageable; (2) deciding to seek help; and, (3) accessing assistance from formal or
informal avenues to remedy the situation (i.e., repair the relationship, protect against
future abuse, leave an abusive situation or relationship; Liang et al. 2005). For m al
avenues of support include seeking mental health, medical, legal, advocacy, and
housing services whereas informal avenues may include asking friends, family, or
co-workers for a safe place to stay, child-care help, financial assistance, or emotional
support (Goodman et al. 2003).
Informal and formal support increase IPV survivors’ sense of self-efficacy and
adaptive coping efforts (Goodman et al. 2005). However, contextual barriers such
as inadequate structural responses (e.g., non-enforcement of protection orders) and
inaccessibility of appropriate resources (e.g., domestic violence shelters) can hinder
IPV-related help seeking (Liang et al. 2005; Overstreet and Quinn 2013). In addition,
barriers to accessing informal support may include experiencing dismissive attitudes
from family or friends after revealing IPV experiences (Weisz et al. 2007). Recent
work considers the cultural context of IPV-related stigma (e.g., loss of status within
social networks because of IPV victimization) in reducing help-seeking behavior in
general (Overstreet and Quinn 2013). Relevant to SGM individuals who experience
IPV victimization, many also face stigma related to their SGM identity when seeking
help (Finneran and Stephenson 2013).
IPV-Related Help-Seeking Patterns Among SGM Individuals
Understanding specific services that SGM individuals utilize following experiences
of IPV victimization has important clinical and public health implications for out-
reach efforts and resource allocation. Similar to cisgender and heterosexual adults,
144 J. R. Scheer et al.
SGM adults initially disclose IPV victimization to informal supports (e.g., friends,
family, co-workers) than to formal supports (e.g., law enforcement, clergy, crisis
lines, shelters; McClennen et al. 2002). When accessing formal services, SGM
individuals may prefer those that covertly address IPV victimization (e.g., men-
tal health counseling) rather than IPV-specific services such as domestic violence
shelters (Hardesty et al. 2011). In addition, rates of disclosure among SGM individu-
als may vary as a function of SGM status, among other demographic characteristics.
For example, sexual minority women are more likely to report IPV victimization to
legal services than sexual minority men due to internalized masculinity norms that
discourage acknowledging victimization experiences (Kuehnle and Sullivan 2003).
Compared to cisgender, heterosexual youth and young adults, help-seeking pat-
terns for IPV victimization may differ for SGM youth and young adults. For instance,
SGM youth who experience IPV victimization, particularly gender minority youth,
may seek formal services such as shelters, transitional living programs, crisis lines,
and advocacy (Scheer and Baams 2019). One recent study demonstrated that among
SGM youth and young adults who experienced IPV victimization, 1.9% sought hous-
ing support, 17.7% sought support services (e.g., advocacy), 21.7% sought medical
care, and 37.8% sought mental health services (Scheer and Baams 2019). However,
while almost a third of SGM young adults experienced IPV victimization in the past
year, less than half of these participants sought IPV-related services (Scheer and
Baams 2019). This same study documented gender identity disparities across sev-
eral of the IPV-related services sought by SGM youth and young adults. Specifically,
gender minority youth and young adults reported 2.06 times the odds of seeking IPV-
related medical care services, 1.66 times the odds of seeking mental health services,
and 2.15 times the odds of seeking support services compared to cisgender, sexual
minority youth and young adults (Scheer and Baams 2019). Gender minority youth
and young adults may be especially vulnerable to accessing affirming informal sup-
port for IPV victimization due to social isolation and anticipated or enacted rejection
of their stigmatized gender identity and thus may turn to formal IPV-related ser-
vices at greater rates than cisgender, sexual minority youth and young adults (Scheer
and Baams 2019; Weisz et al. 2007). Taken together, given the high prevalence of
IPV victimization and relatively low IPV-related help-seeking behavior among SGM
youth and adults, service providers and policy makers should increase their awareness
of risk factors associated with IPV victimization and determinants of help-seeking
patterns and barriers in this population.
Minority Stress as a Social Determinant of Help-Seeking
Barriers Among SGM Individuals
SGM-related stigma creates multiple barriers to seeking and receiving adequate care
and support related to IPV victimization experiences. The current section explores
8 Help-Seeking Barriers Among Sexual and Gender … 145
individual-, interpersonal-, and structural-level minority stressors in relation to IPV-
related help-seeking barriers in this population.
Individual-Level Minority Stressors and IPV-Related
Help-Seeking Barriers
Individual-level minority stressors refer to individuals’ cognitive, affective, and
behavioral responses to stigma (Hatzenbuehler and Pachankis 2016). Specific to
SGM populations, individual-level minority stressors include: (1) internalized het-
erosexism and cissexism (i.e., negative feelings or beliefs about one’s SGM status);
(2) rejection sensitivity (i.e., a learned psychological process whereby SGM individu-
als anticipate stigma-based rejection based on previous discrimination experiences);
and, (3) concealment behaviors (i.e., hiding an SGM status to avoid future victim-
ization; Hatzenbuehler and Pachankis 2016; Mendoza-Denton et al. 2002; Meyer
2003). For SGM individuals who face IPV victimization, the shame associated with
these experiences may be compounded by internalized homophobia, biphobia, and
transphobia, which may have specific ramifications for IPV-related help seeking in
this population (Scheer and Poteat 2018).
SGM individuals who face IPV victimization may internalize negative messages
fueled by laws, policies, and social values that privilege those within the gender
binary, portray homosexuality as deviant, and perpetuate a hegemonic understanding
that only cisgender women—not cisgender men, transgender women, or transgender
men—experience IPV victimization (Guadalupe-Diaz and Jasinski 2017;Helfrich
and Simpson 2006; Scheer and Poteat 2018). These negative feelings and beliefs may
prevent SGM individuals from identifying or addressing abuse within their relation-
ship, further contributing to the denial of abuse, isolation, lack of reporting violence,
and avoidance of seeking help commonly seen in this population (Bornstein et al.
2006; Edwards et al. 2015). Sexual minority men may normalize physical and psy-
chological injuries as part of being a man (i.e., physical strength), and consequently,
may actively work to conceal their IPV victimization (Bacchus et al. 2017). In addi-
tion, SGM individuals who experience IPV victimization fear that seeking help from
formal services may reinforce negative stereotypes about the SGM community in
general, and negative stereotypes about SGM relationships in particular, contributing
to the silence about IPV in this population (Bornstein et al. 2006; Edwards et al. 2015;
Ollen et al. 2017). As such, SGM individuals report interest in covert help such as
through crisis hotlines to avoid further stigmatizing the SGM community (Edwards
et al. 2015).
Experiences of discrimination also contribute to SGM individuals’ sensitivity
to or anticipation of rejection (Hatzenbuehler and Pachankis 2016; Meyer 2003),
which may act as an important barrier to IPV-related help-seeking. Rejection sen-
sitivity refers to the psychological process through which some SGM individuals
146 J. R. Scheer et al.
may anticipate or fear future rejection based on previous experiences of discrim-
ination or prejudice (Mendoza-Denton et al. 2002). Indeed, fear of inappropriate,
insensitive, or discriminatory treatment affects when and where SGM individuals
who experience IPV victimization seek help (Freedberg 2006). For instance, SGM
individuals who experience IPV victimization may choose to avoid seeking help
from legal, mental health, medical, housing, or advocacy services due to the fear
of rejection or stigma from service providers (Ard and Makadon 2011). In addi-
tion, SGM individuals may worry about further victimization by providers who lack
competence in SGM-related issues and by other non-SGM clients accessing similar
services (Bornstein et al. 2006). Expectations of unequal treatment in IPV-specific
programs (e.g., domestic violence shelters) may also contribute to the likelihood that
SGM individuals in general, and sexual minority men and transgender women in
particular, do not seek help (Finneran and Stephenson 2013). SGM individuals may
feel reluctant about reporting IPV victimization to law enforcement given the high
rates of violence, including excessive force, unjustified arrests, and raids of this pop-
ulation by police, especially among sexual minority men and transgender women of
Color (National Coalition of Anti-Violence Programs [NCAVP] 2013). SGM indi-
viduals who experience IPV victimization may also hesitate to seek help from their
religious or faith community or from cisgender, heterosexual friends and family if
they had previous experiences of heterosexism and cissexism in these contexts (Ard
and Makadon 2011).
Experiences of heterosexism and cissexism can lead SGM individuals who face
IPV victimization to conceal their SGM status to avoid future discrimination from
formal and informal sources of support, including healthcare providers, co-workers,
and family members. Both quantitative and qualitative work with SGM individuals
suggests that fears around disclosing one’s own or their partner’s SGM status can
act as a barrier to accessing and engaging in IPV-related support services (Finneran
and Stephenson 2013; Guadalupe-Diaz and Jasinski 2017). Indeed, given that SGM
individuals may carefully manage who knows about their sexual orientation or gender
identity or expression, those who face IPV victimization may not reach out for formal
or informal support and instead will remain in abusive relationships (St Pierre and
Senn 2010). Notably, those who disclose their SGM identity generally report lower
levels of internalized stigma, both of which are associated with increased likelihood
of accessing help following IPV experiences (St Pierre and Senn 2010).
Interpersonal-Level Minority Stressors and IPV-Related
Help-Seeking Barriers
Minority stressors experienced at the interpersonal level include overt forms of preju-
dice and discrimination such as victimization and harassment as well as unintentional
actions including microaggressions (Hatzenbuehler and Pachankis 2016). Concerns
8 Help-Seeking Barriers Among Sexual and Gender … 147
about potential interpersonal prejudice when seeking IPV-related services seem justi-
fiable based on a sizeable literature documenting service providers’ homophobic and
transphobic attitudes towards SGM individuals as well as denial that IPV victimiza-
tion occurs in this population. For instance, Legal (2010) documented that more than
half of all sexual minority individuals in general—not just those who experienced
IPV victimization—reported refusal of needed care, blame for their health status, and
experienced healthcare professionals as physically rough and verbally abusive. SGM
individuals who face IPV victimization often report experiences of police miscon-
duct after the initial violent incident, including excessive force, unjustified arrests,
entrapment, and raids (NCAVP 2013). Moreover, reports of discrimination by service
providers are associated with delayed service usage and reduced likelihood of future
service usage among SGM populations (Jaffee et al. 2016). Indeed, providers’ lack
of awareness of SGM IPV as well as discriminatory attitudes towards SGM popula-
tions contribute to the overall health burden and thwart SGM individuals’ recovery
and healing by preventing those who experience IPV victimization from receiving
adequate care.
Similar to service providers more generally, those who work with IPV survivors
in particular may have received little training on the specific needs of SGM popu-
lations (Simpson and Helfrich 2005). As a result, consistent evidence demonstrates
that among SGM individuals who sought formal help for IPV victimization, many
reported that services were not tailored to SGM individuals’ needs and thus were
perceived as unhelpful and even harmful (Bornstein et al. 2006; Edwards et al. 2015;
St Pierre and Senn 2010). For example, Turell and Cornell-Swanson’s (2005)review
of the help-seeking literature indicated that SGM individuals who experienced
IPV victimization were broadly dissatisfied with formal support services, including
domestic violence agencies, shelters, crisis lines, police, attorneys, and clergy.
Moreover, service providers, including police officers and victim advocates, may
view SGM IPV as less serious than IPV among cisgender, heterosexual individuals,
are less likely to see an SGM person in a same-gender relationship as a victim,
are more likely to see both partners as perpetrators, and perceive violence between
same-gender couples as being less likely to escalate over time (Russell et al. 2010,
2015; Russell and Kraus 2016; Russell 2018; Simpson and Helfrich 2005). As
a result, SGM individuals who experience IPV victimization and report negative
experiences with staff at non-SGM agencies and programs may instead rely on the
SGM community for assistance (Bornstein et al. 2006).
Such experiences of discrimination regarding service usage disproportionately
affect vulnerable subpopulations of SGM people, including transgender women,
sexual minority men, bisexual women, those living in poverty or with HIV, and
SGM individuals who identify as racial, ethnic, or immigrant minorities (Grant et al.
2011; Lambda Legal 2010). These disparities in healthcare quality are especially
concerning because of the heightened need for services—as well as barriers to ser-
vice usage—among these groups. For instance, SGM individuals who are immi-
grants or living in poverty report that their abuser uses the survivor’s financial strain
and/or citizenship status as additional leverage to discourage the survivor from leav-
ing the abusive relationship and accessing IPV-related services (Greenberg 2012).
148 J. R. Scheer et al.
Notably, sexual minority men and transgender individuals underreport IPV victim-
ization to police because of systemic maltreatment from law enforcers (Herek 2002).
Among those who do report IPV victimization, Black gay men are 2.8 times more
likely to experience excessive force from police than those who do not identify
as Black (NCAVP 2016). Moreover, shelters—often the first point of contact for
IPV survivors—are inaccessible to transgender individuals because of the gendered
assumptions of victimization and discriminatory-housing practices in shelters. Gen-
der minority individuals report disbelief from formal service providers about their
IPV victimization experiences either because they are “too butch” or they were
“once a man” (Guadalupe-Diaz and Jasinski 2017). Indeed, enacted stigma reduces
the propensity for seeking help among multiply marginalized SGM individuals who
experience IPV victimization.
Beyond formal help seeking, enacted interpersonal discrimination and prejudice
may also impede informal help seeking for SGM individuals who experience IPV
victimization. Due to hegemonic heterosexism and cissexism, SGM individuals who
face IPV victimization may have fewer options, compared to cisgender, heterosexual
individuals, when seeking informal support such as from family, friends, or clergy
members (Pearson and Wilkinson 2013). Further, SGM individuals often create ‘cho-
sen families’ consisting of friends, mentors, and other members from the SGM com-
munity. While ‘chosen families’ provide an important source of support, accessing
IPV-related support from these networks may be particularly difficult given that many
SGM people in relationships share the same network of SGM peers. Furthermore,
isolating SGM individuals from accessing social support reflects a common tactic of
IPV in general (Bornstein et al. 2006), and of SGM-specific identity abuse (Woulfe
and Goodman 2018). Finally, perpetrators who have not disclosed their SGM identity
for fear of discrimination may deter their partners from forming close friendships
and openly discussing their intimate relationship in effort to continue to conceal their
own stigmatized identity (Walters et al. 2013).
Additional concerns for SGM individuals include fears of losing one’s social
network by disclosing IPV (Ollen et al. 2017). SGM people may hold dismissive
attitudes towards SGM IPV, which may relate to the limited support they can provide.
As is the case with formal help seeking, fears of confirming negative stereotypes
about SGM relationships, or even concerns about outing themselves or their partners
as abusers in the process of seeking informal support, may also reduce informal
help-seeking behavior among SGM people.
Structural-Level Minority Stressors and IPV-Related
Help-Seeking Barriers
Minority stressors at the structural level include societal conditions, cultural norms,
and institutional policies that constrain the opportunities, resources, and wellbeing
8 Help-Seeking Barriers Among Sexual and Gender … 149
of SGM people and contribute to the production of SGM health disparities (Hatzen-
buehler et al. 2013; Hatzenbuehler and Pachankis 2016). Anti-SGM structural stigma
also uniquely hinders SGM individuals from accessing trauma-informed, effective,
and culturally sensitive formal services (Edwards et al. 2015; Helfrich and Simp-
son 2006), particularly among those with multiple stigmatized identities. For exam-
ple, SGM individuals who face IPV victimization and also live with HIV, identify
as people of Color, are sex workers, or live in poverty may experience additional
institutional barriers to accessing formal support (e.g., geographic isolation, lack
of outreach to these communities and transportation options to domestic violence
programs; Miller et al. 2016). Transgender women of Color in particular face dispro-
portionate levels of poverty, discrimination, and denial of health care, contributing to
their overall greater risk for IPV, HIV, and service barriers compared to other SGM
people (Guadalupe-Diaz and Jasinski 2016).
Resulting from the extensive systemic adoption of the gender paradigm that frames
cisgender men as batterers and cisgender women as victims, policy and intervention
services ignore SGM people’s needs and prevent effective and accessible services
for this population (Cannon and Buttell 2015). For example, not until 2013 did the
Violence Against Women Act (1996) include protections for SGM people (Can-
non and Buttell 2015). Perceptions that abuse among SGM people is mutual and
less severe than among cisgender, heterosexual people reflect the justice system’s
gendered model of IPV (Guadalupe-Diaz and Jasinski 2016). These harmful myths
further contribute to the profound difficulty that police officers and service providers
have in assessing for and identifying IPV among SGM individuals (Cannon and
Buttell 2015).
Law enforcement and service providers’ general lack of understanding, language,
and education about SGM IPV may deter SGM individuals who experience IPV vic-
timization from seeking help from general domestic violence services that are not
SGM-specific (Calton et al. 2016; Hamel and Russell 2013). Transgender individu-
als who experience IPV victimization report needing to educate their doctors about
transgender issues to receive adequate care (Grant et al. 2011). Moreover, providers
lack the knowledge and skills related to SGM issues, despite wanting to improve
services for this population (Helfrich and Simpson 2006). Providers’ lack of aware-
ness of SGM issues can result in the expression of non-affirming beliefs through
culturally insensitive policies (Helfrich and Simpson 2006).
Mainstream domestic violence programs may use heterosexist and cissexist lan-
guage in program materials or have ambiguous policies regarding service provision
for SGM people who experience IPV victimization (Helfrich and Simpson 2006;
Miller et al. 2016). One study found that of the 15% of SGM individuals who expe-
rienced IPV victimization and sought shelter services, 21% were denied entry due to
services designated only for cisgender women (NCAVP 2014). In addition, homeless
shelters are often segregated based on sex assigned at birth, which may alienate or
endanger transgender individuals who require housing services to leave abusive sit-
uations (NCAVP 2014; Simpson and Helfrich 2005). Indeed, transgender men may
be less likely to access support from domestic violence shelters due to fears that
their masculine gender expression will result in rejection from service providers and
150 J. R. Scheer et al.
clients (Simpson and Helfrich 2005). In fact, transgender men and women are 3.5
times more likely to experience hate crimes while in shelters compared to cisgender
men and women (NCAVP 2015).
Legal and police remedies represent the least sought forms of help and are often
the least helpful among SGM individuals who experience IPV victimization (Grant
et al. 2011). SGM individuals who experience IPV victimization do not report their
experiences of IPV or seek other types of help from law enforcement given the well-
documented history of violent maltreatment and harassment of SGM communities
by police, especially among SGM people of Color, those living with HIV, transgender
women, immigrants, and sex workers (Nadal et al. 2015). For those SGM individu-
als who do report IPV victimization to the police, the NCAVP found that in 2010,
almost a fourth of SGM people stated that either the victim or both the victim and the
perpetrator were arrested and 29.7% who called the police received no arrest—up
from 21.9% in 2010 (NCAVP 2013). Transgender women are increasingly unlikely
to report IPV victimization to police due to their experiences of harassment and dis-
crimination by law enforcement (Finneran and Stephenson 2013). One study found
that transgender women who experienced IPV victimization were over six times
as likely to report physical violence while interacting with police than cisgender
individuals (NCAVP 2015). These findings are consistent with existing theoretical
and empirical work suggesting that transgender women may face significant struc-
tural barriers to accessing IPV-related legal services due to societal and institutional
transphobia, homophobia, and misogyny (Greenberg 2012;NCAVP2013).
Barriers to accessing legal services among SGM individuals who experience IPV
victimization may directly relate to anti-SGM stigma and discrimination by the jus-
tice system. State laws for protective orders are written using language that excludes
SGM people (Calton et al. 2016). For example, SGM individuals are either omitted
from protection order statutes and thus unable to apply for protection or there lacks
clarity whether SGM individuals are included in the statutes—resulting in inconsis-
tent and biased decisions from local authorities (Potocznick et al. 2003). In 2010, the
NCAVP documented that 55% of the protection order requests were denied among
SGM people who experienced IPV victimization (Calton et al. 2016). SGM survivors
of IPV victimization who have a cisgender or heterosexual partner also face resis-
tance from the courts when attempting to maintain or gain custody over their children
(Courvant and Cook-Daniels 2003). Further, judges may determine the threshold for
obtaining a protection order and thus require that SGM IPV survivors—but not cis-
gender, heterosexual IPV survivors—prove they were cohabitating with their abusive
partner at the time the violence occurred (Calton et al. 2016).
Practice and Policy Implications
Insufficient education in SGM-related issues among mainstream providers and legal
and domestic violence services translates into lack of culturally sensitive care for
SGM individuals who experience IPV victimization. As such, reducing help-seeking
8 Help-Seeking Barriers Among Sexual and Gender … 151
barriers among SGM individuals who experience IPV victimization, requires that
prevention and intervention efforts focus on enhancing SGM-affirmative training
among providers, agencies, and services. To prevent enacted anti-SGM stigma in
healthcare and legal settings, agencies and providers should implement interventions
that promote: (1) the use of SGM-inclusive language and services; (2) awareness of
minority stressors at individual-, interpersonal-, and structural-levels; (3) education
of the bidirectionality of abuse as well as unique power and control dynamics in SGM
relationships; and, (4) awareness of the strengths and resiliencies of this population
(Woulfe and Goodman 2019). Practitioners should also evaluate the accessibility
and availability of their services in terms of inclusivity (e.g., SGM-specific shelters,
gender options beyond man/woman on intake forms), location, and implementa-
tion of SGM-affirmative care (Scheer and Poteat 2018). Providers, agencies, and
legal services should consider consulting with SGM-specific organizations such as
NCAVP, FORGE, and the Northwest Network to ensure SGM-affirmative approaches
to service delivery (Calton et al. 2016).
In order to provide maximally effective services for SGM individuals who expe-
rience IPV victimization, providers, agencies, and services should assess for: (a) the
gender identity and sexual orientation of the survivor and the person using abuse in
the relationship; (b) the frequency and severity of unique tactics of violence that lever-
age systemic oppression such as heterosexism and cissexism (i.e., identity abuse);
(c) psychosocial and health effects of IPV victimization experiences; (d) access to
affirming informal supports that SGM individuals who experience IPV victimization
can seek help from; (e) whether IPV is bidirectional; and, (f) the degree of outness
of the SGM survivor and/or abuser. Ongoing assessment of support systems could
also provide information when making community-based referrals and treatment
recommendations for this population. In addition to facilitating training and assess-
ment among sources of formal support, enhancing SGM-affirming informal support
services for those experiencing IPV victimization also represents a critical public
health and clinical need. Recognizing that SGM individuals disclose IPV more often
to informal supports such as family, friends, and the SGM community than to formal
supports, and that community connectedness protects against the effects of stigma
and violence (Meyer 2003; Scheer and Poteat 2018), activists and allies should con-
tinue to raise awareness of IPV among the broader SGM community and the general
public. Moreover, interventions aimed at informal supports can have positive effects,
including fostering understanding and acceptance of SGM individuals’ minority
statuses and IPV victimization experiences (Edwards et al. 2015).
Trauma-Informed Care for SGM Individuals Who Experience
IPV Victimization
Trauma-informed care (TIC) represents a service delivery approach initially devel-
oped in response to the realization that most people who seek services experience
152 J. R. Scheer et al.
some form of trauma or violence (Harris and Fallot 2001). At its core, a TIC approach
involves providing culturally sensitive services that build on survivor strengths, facil-
itate opportunities for social connection, and foster empowerment to help survivors
regain control (e.g., offering collaborative opportunities during treatment planning;
Elliott et al. 2005). Designed to minimize the risk of re-traumatization while seeking
services, TIC includes six dimensions: (a) fostering agency and mutual respect; (b)
providing psychoeducation about trauma and its effects; (c) increasing opportuni-
ties to connect with other survivors; (d) building on clients’ strengths; (e) cultural
sensitivity; and (f) support for parenting (Elliott et al. 2005; Goodman et al. 2016).
Although TIC does not target specific SGM minority stressors (e.g., identity conceal-
ment, institutional discrimination; Meyer 2003), cultural sensitivity is increasingly
central to healthcare service provision (Elliott et al. 2005). Thus, when applying TIC
principles to SGM individuals who experience IPV victimization in service delivery,
it is critical to include an understanding of—sensitivity towards—the additional and
unique minority stressors that SGM people face (Scheer and Poteat 2018).
Although developed in the context of mental health, TIC principles apply
across various service settings, including medical, housing, and legal services (Miller
et al. 2016). Moreover, previous studies provide substantial evidence for the effec-
tiveness of TIC in addressing and improving numerous psychosocial and health
concerns such as depression, substance use, physical health concerns, shame, and
loneliness among those who experience trauma—including SGM individuals who
face IPV victimization (Butler et al. 2011). TIC should be delivered in con-
junction with evidence-based treatment protocols adapted for SGM populations
(e.g., SGM-affirmative cognitive-behavioral therapy; Pachankis 2014) to improve
the psychological functioning and health for this population.
System-Level Changes to Address Structural Barriers to Help
Seeking
Federal and local policies that protect SGM civil rights consequently disrupt the
social exclusion and societal-level stigma faced by SGM survivors of IPV victim-
ization and could ultimately reduce the overall health burden in this population.
Anti-SGM systemic and institutional policies need to be addressed and reformed
such as including SGM individuals in protection orders statutes (Calton et al. 2016).
In addition, passing legislation that renders systematic discrimination against SMG
people (e.g., housing and employment discrimination) illegal, may help to improve
societal acceptance of this population. Increasing awareness of SGM IPV could
increase funding and allocation of services specific to this population. Finally, it is
important for activists and researchers to monitor the implementation of the Violence
Against Women Act to ensure domestic abuse networks provide equitable services
for LGBTQ survivors.
8 Help-Seeking Barriers Among Sexual and Gender … 153
Summary and Future Directions
This chapter highlights the increased prevalence of IPV victimization for SGM indi-
viduals compared to cisgender, heterosexual individuals. Estimates suggest that 23–
63% of SGM individuals experience at least one form of IPV victimization—two-fold
the prevalence among cisgender, heterosexual individuals. As previously mentioned,
IPV victimization is clearly detrimental to SGM people’s health and wellbeing: SGM
individuals who experience IPV victimization have poorer mental and physical health
outcomes such as posttraumatic stress disorder, depression, anxiety, substance use,
chronic health conditions, HIV, and suicidality compared to SGM people who do not
face IPV victimization. Risk is further amplified for SGM individuals of Color and
immigrant minorities who navigate multiple systems of oppression that perpetuate
stigma associated with race/ethnicity, sexual orientation, gender identity/expression,
and IPV victimization (Miller et al. 2016).
Stigma related to IPV victimization experiences and SGM status creates multiple
barriers to seeking and receiving adequate care and support. First, individual-level
barriers include minority stress processes (e.g., internalization of negative beliefs
about one’s identity or experiences and fearing rejection and unequal treatment by ser-
vice providers or family and friends) that may prevent SGM individuals from seeking
help or disclosing their experiences of IPV victimization. Second, interpersonal-level
barriers include experiences of discrimination and prejudice by service providers,
law enforcers, family, friends, and clergy members, or isolation from SGM commu-
nities (e.g., identity abuse). Third, minority stressors at the structural level include
cultural norms and societal conditions that prevent SGM individuals from receiving
the support they need, such as a lack of effective care and services tailored to this
population.
Future directions. Although research on SGM IPV consistently shows dispar-
ities related to sexual orientation and gender identity/expression, we have limited
information about IPV victimization and barriers to service usage among certain
SGM subgroups, for example transgender and gender non-binary individuals. Data-
collections—local and federally mandated—should include comprehensive mea-
sures of sexual orientation and gender identity/expression to identify at-risk SGM
groups and their unique experiences, relationship trajectories, and service needs.
More research is needed to better understand the risk factors for bidirectional IPV
among SGM people as well as service use and barriers to help-seeking among SGM
people who perpetrate IPV. In addition, considering that existing research high-
lights increased risk of IPV victimization experiences among SGM individuals of
Color and immigrant minorities, future work should focus on mechanisms of risk,
marginalization, and discrimination as barriers to help seeking in these communities.
Further, research discussed in this chapter highlights the risks of IPV victimization
experiences among SGM adolescents and young adults. We currently know very
little about how SGM youth navigate their first intimate relationships, nor do we
have any knowledge on how previous experiences with rejection and violence in the
peer-context impact their intimate relationships or help-seeking behaviors.
154 J. R. Scheer et al.
As outlined in this chapter, efforts are being made to reduce help-seeking barriers
among SGM individuals who experience IPV victimization, for example affirmative
training and tailoring interventions to SGM individuals’ needs. However, work still
needs to be done to evaluate the effectiveness, accessibility, and inclusiveness of
intervention approaches such as trauma-informed care for SGM individuals who
experience IPV victimization.
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Jillian R. Scheer is a T32 postdoctoral research fellow at the Center for Interdisciplinary
Research on AIDS at the Yale School of Public Health and a counseling psychologist. Jillian’s
research focuses on identifying the co-occurring epidemics (i.e., syndemics such as intimate part-
ner violence, sexual assault, posttraumatic stress disorder, substance use) facing at-risk sexual and
gender minority individuals.
Alexa Martin-Storey is an associate professor at L’Université de Sherbrooke and holds the
Canada Research Chair in Stigma and Psychosocial Development. Her work addresses the link
between stigma and interpersonal processes among adolescents and young adults, with a particular
focus on sexual and gender minority populations.
Laura Baams is an assistant professor in the Pedagogy and Educational Sciences department
of the University of Groningen, the Netherlands. Her work focuses on mental health disparities
among LGBTQ adolescents and young adults.
... In contrast with what we expected based on the literature, sexual and gender minorities and cultural minorities in our sample did not report high levels of otheringbased stress, as defined by a mean score > 4 on the five-point scale. Nevertheless, as we hypothesized in line with other studies [90][91][92][93][94], othering-based stress is positively associated with sexual victimization observed in minority groups. The finding that OBS predicted the odds of sexual victimization despite the moderate overall level of OBS in the SI-minority sample suggests that experiencing othering status may be a powerful vulnerability factor. ...
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... Previous experiences of heterosexism or cissexism may well lead to service users concealing their identity to avoid discrimination from health care professionals (Pachankis 2007;Scheer et al. 2020). This makes it particularly important that alcohol service providers ask clients about identity and acknowledge the broader societal and structural factors which influence drinking practices (see also Keogh et al. 2009), rather than focusing narrowly on alcohol consumption. ...
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... Some studies suggest that AGM individuals use services at higher rates than heterosexual individuals (Dunbar, Sontag-Padilla, Ramchand, Seelam, & Stein, 2017;Platt, Wolf, & Scheitle, 2018). In contrast, other studies report reduced engagement in treatment (Burgess, Tran, Lee, & van Ryn, 2007;Richardson, Armstrong, Hines, & Reed, 2015;Scheer, Martin-Storey, & Baams, 2020). Whereas AGM individuals may initially engage at higher rates, this may not translate to treatment retention. ...
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Identity abuse (IA) comprises a set of abuse tactics that exploit discriminatory systems including homophobia, biphobia, and transphobia (Tesch & Berkerian, 2015). This study examined the factorial validity of the IA Scale (Woulfe & Goodman, 2018) with a large independent sample of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. Participants included 1,049 LGBTQ‐identified participants (Mage = 27.3, 71.9% White, 52.6% cisgender women, and 18.7% as other nonheterosexual identity in their sexual orientation), recruited through listservs. Participants completed an online survey measuring past‐year and adult exposure to identity, physical, and psychological abuse. Confirmatory factor analysis indicated that the measurement model had good fit to the data, and strong factor loadings were found across the seven items, confirming a unidimensional factor structure. Findings demonstrate the IA Scale's validity and reliability, supporting its use to assess the frequency of IA tactics experienced within intimate partnerships among LGBTQ individuals.
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Intimate partner violence (IPV; i.e., physical, sexual, or psychological abuse by a current or former partner) remains a public health concern with devastating personal and societal costs. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are also vulnerable to a dimension of IPV called identity abuse (IA); that is, abuse tactics that leverage systemic oppression to harm an individual. Yet, we know little about its relative prevalence in subgroups of the LGBTQ community. This study developed and evaluated a measure of IA, and explored its prevalence in a sample of 734 sexual minority adults. The sample included women (53.1%), men (27.4%), and transgender or gender nonconforming "TGNC" (19.3%) participants. The majority of participants identified as queer or pansexual (38.7%), then gay (23.6%), lesbian (22.8%), and bisexual (13.6%). Participants completed an online survey that included measures of IA and physical, sexual, and psychological abuse. The IA items formed a unidimensional factor structure with strong internal consistency and construct validity. Nearly one fifth of the sample (16.8%) experienced past year IA and 40.1% reported adult IA. Women experienced greater exposure to IA in adulthood than men, and TGNC participants reported higher rates of IA in adulthood and in the last year compared to their cisgender counterparts. The odds of queer or bisexual participants reporting IA in adulthood were almost three times higher than gay participants, and two times higher than lesbian participants. Findings have implications for advancing assessment of partner abuse in the LGBTQ community, LGBTQ-competent clinical care, and training of practitioners.
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Intimate partner violence (IPV) is a serious public health problem, linked with a number of poor health outcomes. Some research demonstrates that transgender and gender nonconforming (TGNC) youth may experience IPV at similar rates to heterosexual cisgender women; however, there is a dearth of data examining the experiences of IPV among this population. The exclusion of TGNC youth in IPV research and public health interventions is problematic because it contributes to a traditional gender-based heterosexual model of IPV that ignores the specific needs of TGNC populations. Given the pervasiveness of transphobic stigma in the United States and the complexities of the lives of TGNC youth, it is important to understand how both structural and individual factors are associated with IPV among TGNC youth. Using data from a cross-sectional survey of 131 TGNC youth from 14 different cities in the United States representing various regions of the country, this study explores the associations between a range of structural and intrapersonal factors and experiences of IPV victimization among TGNC youth. Separate logistic regression models were fit to examine the relationships between structural and intrapersonal factors and IPV. Structural results found that TGNC youth experiencing extreme victimization, a history of incarceration, and participation in sex work were much more likely to report IPV. The only intrapersonal variable that was associated with IPV was depressive symptomatology; however, this relationship was strong, with participants being nearly eight times more likely to report IPV if they experienced symptoms of depression. Gaining a better understanding of the complexity of both structural and intrapersonal factors among TGNC youth will greatly inform the development of IPV prevention and services for TGNC youth experiencing this type of violence.
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Available data indicate that 55% of women and 20% of men living with HIV infection experience intimate parter violence (IPV) and that 24% of women experience abuse by their partners after disclosing their HIV serostatus. IPV increases the risk of HIV acquisition and often interferes with victims' engagement in and adherence to HIV care. The processes of integrating IPV screening as part of a health-centered approach in the HIV clinic are discussed. This article is based on a presentation by Tami P. Sullivan, PhD, at the 2018 Clinical Conference at the National Ryan White Conference on HIV Care and Treatment in December 2018.
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Sexual and gender minority youth, especially those assigned female at birth, are at risk for intimate partner violence (IPV) due to minority stressors. With a sample of 352 sexual and gender minority youth assigned female at birth (age 16–32), we aimed to describe IPV in this population, including the prevalence, directionality, frequency, co-occurrence, and demographic correlates of various IPV types. Rates of past-6-month IPV were high, with victimization and perpetration of minor psychological IPV most common (64–70%); followed by severe psychological, minor physical, and coercive control (21–33%); and severe physical and sexual IPV (10–15%). For cyber abuse and IPV tactics leveraging anti-sexual minority stigma, victimization (12.5% and 14.8%, respectively) was more common than perpetration (8% and 5.7%, respectively). Most IPV was bidirectional and occurred 1–2 times in 6 months, although the frequency varied considerably. Latent class analyses revealed that half of the participants reported no or minimal IPV; one-third experienced multiple forms of psychological IPV (including coercive control); and 10–15% reported psychological, physical, sexual, and cyber abuse. Racial minority youth had higher rates of most IPV types than White participants. We hope study findings will inform policies and interventions to prevent IPV among gender and sexual minority youth assigned female at birth.
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This study tested direct and indirect associations between minority stressors and psychological distress a large, geographically diverse sample of transgender individuals (N = 1,207). Transgender individuals were recruited for an online, cross-sectional survey using targeted sampling. Structural equation modelling was used to test the hypothesized model, which was based on Hatzenbuehler's (2009) integrative mediation framework. Expectations of rejection, self-stigma and prejudice events were all associated with psychological distress, and these relationships were partially accounted for by rumination. This model had good fit (TLI = .96, CFI = .98, RMSEA = .05 (90% CI [.05, .06]) and explained 54.5% of the variance in psychological distress and 29.3% in rumination. This is the first study to examine a model of minority stress and psychological distress that includes rumination and all four minority stressors from Meyer's (2003) framework in a large sample of transgender individuals. Results indicate a strong relationship between minority stressors and psychological distress among transgender people, and that these relationships are partially explained by rumination. Results need to be considered in relation to the cross-sectional nature of the design and the possible role for additional variables. Future research should investigate these findings using designs that provide tests of causality.