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Transgender Dehumanization and Mental Health: Microaggressions, Sexual Objectification, and Shame

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Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender women and men, this project extends the pantheoretical dehumanization framework by testing direct and indirect relations between dehumanization (i.e., a higher-order construct from experiences of transgender microaggressions and sexual objectification), internalization processes (i.e., internalized transnegativity, self-objectification), shame, and general mental health. The model explained 55% of the variance in general mental health. Direct relations between dehumanization and all internalization processes were positive and significant. Internalized transnegativity and shame were significant, negative, direct predictors of mental health, but neither dehumanization nor self-objectification was a significant direct predictor of transgender mental health. Both self-objectification and internalized transnegativity directly predicted more feelings of shame. However, only shame yielded a significant indirect pathway from dehumanization to mental health. The indirect relations from self-objectification and internalized transnegativity to mental health through shame were significant. Research, advocacy, and clinical implications are discussed. In press with The Counseling Psychologist, slated for publication April 2023.
Transgender Dehumanization and Mental Health:
Microaggressions, Sexual Objectification, and Shame
Cory J. Cascalheira1 and Na-Yeun Choi2
1 New Mexico State University, 2 Dankook University
In press with The Counseling Psychologist, slated for publication April 2023
The authors thank Dorian and JT for providing critical feedback to ensure cultural
sensitivity of the survey for use with the transgender community. They also thank the
anonymous peer reviewers whose feedback substantially improved the quality of the manuscript.
This project was supported by the Mamie Phipps Clark Diversity Research Grant, in the
amount of $1,500, awarded by Psi Chi to Cory J. Cascalheira. Cory J. Cascalheira also is
supported by the National Institutes of Health Research Training Initiative for Student
Enhancement program (R25GM061222).
Author Note
Cory J. Cascalheira
Correspondence concerning this article should be addressed to Cory J. Cascalheira,
Department of Counseling & Educational Psychology, New Mexico State University, MSC
3CEP, P.O. Box 30001, Las Cruces, New Mexico 88003-8001. Email:
Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender
women and men, this project extends the pantheoretical dehumanization framework by testing
direct and indirect relations between dehumanization (i.e., a higher-order construct from
experiences of transgender microaggressions and sexual objectification), internalization
processes (i.e., internalized transnegativity, self-objectification), shame, and general mental
health. The model explained 55% of the variance in general mental health. Direct relations
between dehumanization and all internalization processes were positive and significant.
Internalized transnegativity and shame were significant, negative, direct predictors of mental
health, but neither dehumanization nor self-objectification was a significant direct predictor of
transgender mental health. Both self-objectification and internalized transnegativity directly
predicted more feelings of shame. However, only shame yielded a significant indirect pathway
from dehumanization to mental health. The indirect relations from self-objectification and
internalized transnegativity to mental health through shame were significant. Research,
advocacy, and clinical implications are discussed.
Keywords: transgender, objectification theory, discrimination, transphobia,
Significance of the Scholarship to the Public
This study advances the roles of microaggressions, negative feelings about one’s gender
identity, treating the self like an object, and shame in explaining the mental health disparities
observed in the transgender community. When working with transgender clients, clinicians
should target internalization processes and shame to improve mental health. Activists should
attend to both microaggressions and objectifying treatment in policy work.
Transgender Dehumanization and Mental Health:
Microaggressions, Sexual Objectification, and Shame
Compared to their cisgender peers (i.e., people whose gender matches social expectations
of their assigned sex at birth), transgender people (i.e., individuals whose gender does not match
the social expectations connected to their sex assigned at birth) disproportionately experience
poorer mental health (Austin & Goodman, 2017; Bockting et al., 2013; Bouman et al., 2017;
Bradford et al., 2013). While researchers have investigated this adverse outcome by attending to
discrimination (e.g., Valentine & Shipherd, 2018), fewer have examined dehumanization, an
intergroup phenomenon in which minority groups are denied uniquely human characteristics
(i.e., experience discrimination) and their human nature (i.e., subjected to sexual objectification;
Moradi, 2013). For example, a transgender woman is dehumanized when a person is unfriendly
towards her because of how she dresses (discrimination) and when another person makes rude
sexual remarks about her body (sexual objectification). The simultaneous investigation of
discrimination and sexual objectification is important because transgender people in the United
States (U.S.) routinely experience both processes. At the institutional level, for instance, 27 states
have harmful or bare minimum protections against discrimination based on one’s gender identity
(Movement Advancement Project, 2020). At the interpersonal level, transgender people
experience high rates of rape and sexual harassment (e.g., Tebbe et al., 2016), which are forms of
sexual violence whose acceptance is associated with objectified bodies (Seabrook et al., 2019).
Given this oppressive context, sequalae flowing from environmental discrimination and sexual
objectification may explain the variance in transgender mental health.
Pantheoretical Dehumanization: A Model
Pantheoretical dehumanization is the unification of various stigma-based, group-specific,
and oppression-oriented frameworks within counseling psychology to explain the affective,
cognitive, and physiological consequences of being dehumanized in a single model (Moradi,
2013). Two notable frameworks with relevance to transgender people are discrimination theories
(e.g., minority stress and microaggressions; Meyer, 2003; Nadal, 2019a) and objectification
theory (Fredrickson & Roberts, 1997). This paper focuses on the ways in which environmental
experiences of discrimination and sexual objectification cohere to predict deleterious outcomes
through internalization processes. That is, when a transgender person is dehumanized, Moradi’s
(2013) pantheoretical framework asserts that: (a) discrimination and sexual objectification are
often co-occurring in the person’s social environment (i.e., their lived experience); (b)
internalization processes specified by discrimination theories and objectification theory are set in
motion; (c) internalization processes interact within the person to trigger affective/cognitive
responses; and (d) adverse mental health outcomes result. Accordingly, drawing on Moradi’s
(2013) theoretical postulates, we argue that (a) when sexual objectification and
microaggressions, or brief everyday forms of discrimination reflecting implicit biases (Nadal et
al., 2014), occur in a transgender person’s environment, then (b) self-objectification and
internalized transnegativity are probable internalization consequences which, in turn, (c) interact
with and stimulate feelings of shame and (d) result in poorer mental health.
Given that pantheoretical dehumanization manifests as discriminatory and objectifying
experiences (Moradi, 2013), we expected microaggressions and sexual objectification to be
accounted for by a higher-order dehumanization factor in our model. Both processes involve
rejecting the transgender person’s humanity. Moreover, transgender microaggressions frequently
include the exoticization or fetishization of the transgender body (Anzani et al., 2021; Nadal et
al., 2016), thereby overlapping with sexual objectification.
Dehumanization as Microaggressions
Researchers have applied pantheoretical dehumanization to transgender women
(Brewster et al., 2019) and men (Velez et al., 2016), and focused on minority stress theory
specifically (Meyer, 2003). Most research using a minority stress perspective focuses on major
discriminatory events (e.g., harassed for using a bathroom consistent with one’s gender; Balsam
et al., 2011). However, focusing on microaggressions is important for several reasons. First,
because microaggressions are common and pervasive even when blatant discrimination is
prohibited by law (Nadal, 2019a), as transgender people gain protected status in the U.S.,
dehumanization may be more likely to continue via microaggressions. Second, since
microaggressions are sometimes unconscious or unintentional (Nadal et al., 2016), perpetrators
of microaggressions may not understand how their actions are harmful (Balsam et al., 2011),
which may make this form of discrimination more difficult for transgender people to resolve.
Third, microaggressions are often subtle, brief, daily occurrences (Nadal et al., 2014), suggesting
that a transgender person is more likely to experience them as opposed to major discriminatory
events. Finally, microaggressions have conceptual significance in the pantheoretical model
(Moradi, 2013), but are yet untested despite their health-eroding potential (Nadal, 2019b; Nadal
et al., 2012), and thus warrant investigation.
Minority stressors in general, and microaggressions in particular, are linked to poor
mental health among sexual and gender minorities (SGM; Bockting et al., 2013; Bradford et al.,
2013; Nadal, 2019a; Nadal et al., 2011, 2016). Microaggressions targeting sexual minorities are
related to depression (Salim et al., 2019), anxiety and distress (Scharer & Taylor, 2018;
Woodford et al., 2015), and less behavioral control (Scharer & Taylor, 2018). A longitudinal
study where 26.2% of participants identified as transgender found that more frequent experiences
of microaggressions were associated with greater psychiatric symptoms (Dyar et al., 2020).
Moreover, misgendering (i.e., a type of microaggression) also is associated with psychological
distress (McLemore, 2018). Thus, if microaggressions are part of a higher-order dehumanization
factor (Moradi, 2013), then a negative relationship with transgender mental health is expected.
Dehumanization as Sexual Objectification
Examining sexual objectification concurrently with microaggressions distinguishes
pantheoretical dehumanization from frameworks focusing solely on discrimination. Among
transgender people, objectification-based dehumanization has been linked to less behavioral
control (Brewster et al., 2019; Velez et al., 2016). However, sexual objectification also is
associated with poorer mental health generally. In objectification theory, Fredrickson and
Roberts (1997) argued that “psychological consequences [...] spring from objectifying treatment”
(p. 174). Among cisgender people (Fredrickson & Roberts, 1997), for example, evidence
suggests that anxiety (Moradi & Huang, 2008) and depression (Szymanski, 2020) spring from
environmental experiences of sexual objectification. Flores et al. (2018) found that transgender
people of color were concerned with both appearance anxiety and physical safety anxiety.
Evidence also suggests that sexual objectification increases distress for some transgender people
(Anzani et al., 2021). Thus, if sexual objectification is part of a higher-order dehumanization
factor as hypothesized (Moradi, 2013), then it may detract from transgender mental health.
Internalization Processes
Internalized Transnegativity
Previous studies using pantheoretical dehumanization tested models with an emphasis on
objectification-related internalization variables (e.g., body surveillance; Brewster et al., 2019;
Velez et al., 2016). Therefore, to test whether discrimination-based internalization processes
drive outcomes in the pantheoretical model, this study focuses on internalized transnegativity, or
the translation of negative societal messages into debasing self-perceptions of one’s gender
identity (Israel et al., 2020), an internalization process predictive of general mental health
(Bockting et al., 2020).
While dehumanization as a higher-order construct of microaggressions and sexual
objectification has yet to be linked to internalized transnegativity empirically, transgender
microaggressions are an expression of societal stigma (Austin & Goodman, 2017) and function
as distal stressors (i.e., minority-specific stress in the environment; Arayasirikul & Wilson, 2019;
Nadal et al., 2016) which then become internalized proximal structures (i.e., habitual affective
and cognitive responses; Meyer, 2003). Therefore, the link is conceptually evident albeit
empirically untested. We expected a significant pathway from dehumanization to internalized
transnegativity because, as transgender people encounter subtle discrimination (e.g., called by
the wrong pronouns) and sexual objectification (e.g., intrusive questions about their genitalia;
Anzani et al., 2021), they may start to feel uncomfortable disclosing or embarrassed about their
identity (i.e., aspects of internalized transnegativity; Bockting et al., 2020). Internalizing these
dehumanizing societal attitudes was expected to detract from mental health given that negative,
identity-based self-perceptions increase adverse symptoms (Bockting et al., 2013; Meyer, 2003;
Puckett et al., 2020; Puckett & Levitt, 2015). Consequently, internalized transnegativity might
partially explain the link between dehumanization and transgender mental health.
One intermediate process in the link between objectification-based dehumanization and
mental health is self-objectification (Fredrickson & Roberts, 1997; Moradi, 2013). Self-
objectification emerges from “internalizing an observer’s perspective” (Fredrickson & Roberts,
1997, p. 180). The main reason nonbinary transgender people were excluded from the present
study is due to the potential differences in how self-objectification occurs in transgender
nonbinary versus binary groups. Nonbinary people, for instance, may resist sociocultural
standards of attractiveness (Cusack & Galupo, 2021), possibly buffering them against self-
objectification. On the other hand, binary transgender people might be uniquely susceptible to
treating the body as the self (i.e., valuing physical appearance over other personal attributes;
Lindner & Tantleff-Dunn, 2017) because (a) there are clear social expectations for female and
male bodies, (b) passing as cisgender is a common expectation, and (c) these expectations are
frequently signaled by others (Anzani et al., 2021; Bockting et al., 2020; Flores et al., 2018).
Previous research using pantheoretical dehumanization found support for objectification-
based internalization processes (Brewster et al., 2019; Velez et al., 2016). Both studies examined
body surveillance (i.e., a habit of monitoring bodily appearance; Fredrickson & Roberts, 1997),
which is substantively distinct from self-objectification (Lindner & Tantleff-Dunn, 2017; Moradi
& Huang, 2008). Since transgender people report internalizing their objectifying experiences
(Flores et al., 2018), self-objectification warrants further examination as a direct and indirect
variable in the pantheoretical framework for several reasons. First, self-objectification makes it
more difficult to value internal characteristics (e.g., intelligence, creativity; Fredrickson &
Roberts, 1997), which may result in greater distress. Second, fetishizing microaggressions may
translate into treating the body as the self (e.g., “settl[ing] for being the fetish”; Anzani et al.,
2021, p. 7). Third, self-objectification is a significant mediator of sexual objectification and
mental health in cisgender people (e.g., Jones & Griffiths, 2015).
Affective Response: Feelings of Shame
We included shame (i.e., a painful negative emotion based on the self as undesirable;
Gilbert, 1998) as an affective mechanism in the pantheoretical framework because shame is “a
health-corrosive emotion” (Scheer et al., 2020, p. 139). General processes like shame flow from
discrimination (Hatzenbuehler, 2009), such as when SGM adults report feeling ashamed
following microaggressive experiences (Nadal et al., 2011). Body shame is a common correlate
of sexual objectification (Watson & Dispenza, 2015) and may generalize to global feelings of
shame when compounded by microaggressions. That is, transgender people may not only
develop shame about their bodies in dehumanizing interactions but may also receive messages
about how their gender/sex/identity “fails” to meet cissexist standards. Perceived failure in
meeting social standards generates feelings of shame (Fredrickson & Roberts, 1997).
Shame is associated with variables in the pantheoretical model. Prior research found links
between shame, minority stressors, and poorer mental health in samples of SGM individuals
(Mereish et al., 2019; Mereish & Poteat, 2015; Scheer et al., 2020), but transgender people tend
to be underrepresented (Tebbe et al., 2016). In terms of sexual objection, Flores et al. (2018)
found that transgender people of color reported feeling ashamed when others comment on or
stare at their bodies. While the scope of shame is narrow in prior research with transgender
samples, cisgender women prone to feelings of embarrassment and inferiority were likely to
report more objectifying experiences and symptoms of depression (Szymanski, 2020). Because
shame involves feelings of being helpless, ridiculous, and disgusting (Harder & Zalma, 1990),
transgender people who are dehumanized may feel bad about their gender identity or believe that
their worth derives from their potential as sexual objects. Consequently, we tested shame (a) as a
direct predictor of mental health and (b) as a mediator between the internalization processes and
mental health. Since shame may also flow directly from dehumanization (Nadal et al., 2011;
Watson & Dispenza, 2015), we examined the direct path from dehumanization to shame as well.
The Present Study
The present study sought to test whether dehumanization would predict general mental
health through internalization processes and shame. Five main hypotheses (H) were specified.
We predicted that microaggressions and sexual objectification would be significant positive
indicators of a higher-order dehumanization factor (H1). We also predicted that greater
dehumanization would directly predict higher levels of shame (H2a), self-objectification (H2b),
and internalized transnegativity (H2c) but lower levels of mental health (H2d). We expected
higher levels of self-objectification to be associated with higher levels of shame (H3a) and lower
levels of mental health (H3b); higher levels of internalized transnegativity to be related to higher
levels of shame (H3c) and lower levels of mental health (H3d); and greater shame to have a
negative relation to mental health (H3e). Further, significant indirect relations between
dehumanization and mental health will be observed through shame (H4a), self-objectification
(H4b), and internalized transnegativity (H4c). Finally, significant indirect relations will be
observed from internalized transnegativity to mental health (H5a) and from self-objectification to
mental health (H5b) through shame.
Procedure and Participants
Following best practices with transgender populations (Tebbe & Budge, 2016), the
survey instruments were pilot tested with three trans individuals to ensure cultural
appropriateness. Feedback was incorporated (e.g., changing the wording of demographic
questions, altering recruitment materials) and ethical approval obtained prior to recruiting a
nonprobability sample from online communities (e.g., Tumblr, Reddit, Facebook). After passing
a reCAPTCHA test and providing consent, participants completed a demographic form and six
measures via REDCap, were debriefed, and had an opportunity to enter a raffle to win a $25 gift card. Data were collected from June 2020 to February 2021. In terms of
reproducibility, data and materials were hosted on the Open Science Framework (OSF;
Cascalheira, 2020); the project was preregistered.
Data were from a larger data set involving the transgender community (Cascalheira et al.,
in press). The larger data set was used for an instrument validation study. Of the 618 transgender
women and men who started the survey, 185 were removed for incomplete data, 77 for failing at
least one attention check, 35 for living outside the U.S., 16 for not entering an age, 11 for
identifying as cisgender, and 2 for not providing consent. Hence, 292 responses were analyzed,
an adequate sample size for structural equation modeling (SEM; Weston & Gore, 2006). Data
were missing completely at random (Little’s MCAR
[1896] = 1840, p = .817), the amount of
missing data was low (0.16%), the sample size was relatively large, and the subscales evinced
adequate internal consistency, so mean imputation was used (Parent, 2013).
Inclusion criteria consisted of being over the age of 18, identifying as binary transgender,
and living in the U.S. The 292 participants (
= 29.1;
= 12.5) reportedly identified as
trans men (75.7%) and trans women (24.3%). They reported the following sexual orientations:
45.9% bi+, 14% gay, 11.3% heterosexual, 10.3% queer, 8.9% lesbian, 5.5% other, and 3.8%
asexual (0.3% no response). In terms of ethnicity, 73.3% of participants identified as European
American, 11.0% multiethnic, 5.8% Latin American, 3.4% African / Caribbean American, 3.4%
other, and 3.1% Asian American. They lived on the East Coast (28.8%), in the Midwest (24.3%),
West Coast (19.5%), Southwest (11.3%), Southeast (8.2%), Rocky Mountains (6.9%), and
Alaska / Hawai’i (0.7%; 0.3% no response). Regarding annual income, 48.6% earned less than
$20,000, 29.8% earned $20,000 to $44,999, 16.4% earned $45,000 to $139,999, and 3.8% made
more than $140,000 (1.4% no response). In terms of their highest education, participants
attended some college (34.9%), held a bachelor’s degree (18.8%), graduated high school
(15.4%), went to graduate school (12.0%), earned an associate degree (10.3%), did not graduate
high school (5.1%), or held a tradeperson certificate (3.1%).
Experiences of Sexual Objectification
Self-reported incidents of sexual objectification were assessed with the Interpersonal
Sexual Objectification Scale (ISOS; Kozee et al., 2007). Kozee and colleagues originally derived
a two-factor solution from the set of 15 items with female participants while Davidson et al.
(2013) found a three-factor solution with a sample of college men; both models are conceptually
consistent with a higher-order factor of interpersonal sexual objectification. Items, rated on a 5-
point Likert-type scale ranging from 1 (never) to 5 (almost always), express body evaluation,
unwanted explicit sexual advances, and body gazes (e.g., “How often have you noticed someone
leering at your body?”). Higher scores indicate more frequent incidents of sexual objectification.
The ISOS is stable over a three-week period (r = .90) and, regarding discriminant and convergent
validity, ISOS total scores exhibit moderate to strong correlations with measures of sexist events,
body consciousness, and body shame among female individuals (Kozee et al., 2007). In a sample
of transgender women, an estimate of internal consistency was excellent (α = .95; Brewster et al.,
2019). Cronbach’s coefficient alpha for the present sample was .94.
Transgender Microaggressions
Brief, often subtle, everyday experiences of discrimination based on one’s transgender
identity were assessed with the Gender Identity Microaggressions Scale (GIMS; Nadal, 2019b).
Although the GIMS presently lacks robust validity evidence, it was the only scale assessing
transgender microaggressions. Participants responded to 14 items dichotomously (1 = yes, 0 =
no) to indicate whether denial of gender identity, misuse of pronouns, invasion of bodily privacy,
behavioral discomfort, or denial of societal transnegativity had occurred within the last six
months (e.g., “Someone [e.g., family, friend, co-worker] has asked me personal questions about
gender reassignment.”). Higher scores indicate more frequent microaggressions. The measure
was normed on both transgender women and men. Internal consistency in the original study
was .76 (Nadal, 2019b). In the present sample, Kuder-Richardson formula 20 was strong (.83).
The extent to which participants internalize objectification was measured with the Self-
Objectification Beliefs and Behaviors Scale (SOBBS; Lindner & Tantleff-Dunn, 2017). Fourteen
items measure the internalization of interpersonal perspectives (e.g., “I try to imagine what my
body looks like to others [i.e., like I am looking at myself from the outside]”) and the valuing
physical attributes over internal qualities (e.g., “My physical appearance says more about who I
am than my intellect”). Response choices range from 1 (strongly disagree) to 5 (strongly agree);
higher scores indicate higher levels of self-objectification. In terms of validity evidence,
significant positive correlations between scores on the SOBBS Total Scale and scores on
measures of objectifying experiences, body shame, appearance anxiety, disordered eating, and
depressive symptoms were observed (Lindner & Tantleff-Dunn, 2017). The test-retest reliability
(r = .89) and internal consistency estimate (α = .91) of the SOBBS Total Scale were excellent.
Cronbach’s coefficient alpha in the present study was .88.
Internalized Transnegativity
Discomfort with one’s transgender identity as a result of internalizing cisnormative
messages was assessed with the Transgender Identity Survey (TIS; Bockting et al., 2020). Factor
analysis confirmed a four-factor solution with 26 items, which range from 1 (strongly disagree)
to 7 (strongly agree). Participants responded to statements for subscales of Passing (e.g.,
“Passing is my biggest concern”), Alienation (e.g., “I’m not like other transgender people”), and
Shame (e.g., “I envy people who are not transgender”). The Pride subscale (e.g., “Being
perceived as transgender by others is okay for me”) is reverse scored. All items inquire about
feelings over the last three months and higher scores indicate greater internalized transnegativity.
TIS total scores are negatively correlated with outness and self-esteem and positively correlated
with depression, anxiety, and felt stigma (Bockting et al., 2020). One-week test-rest reliability (r
= .93) and internal consistency (α = .90) for total scores were excellent. Cronbach’s coefficient
alpha in the present sample was .94.
Feelings of Shame
The intermediate process of shame was quantified with the Shame subscale of the
Personal Feelings Questionnaire-2 (PFQ2-Shame; Harder & Zalma, 1990). This 10-item subscale
measures feelings of shame (e.g., feeling laughable) over the last year on a 4-point scale ranging
from 0 (you never experience the feeling) to 4 (you experience the feeling continuously or almost
continuously). Higher scores indicate greater feelings of shame. In addition to excellent test-
retest reliability (r = .91), PFQ2-Shame exhibits significant positive correlations with depression,
self-derogation, and anxiety. In the original study, Cronbach’s coefficient alpha was .78 (Harder
& Zalma, 1990). However, in community samples of SGMs, internal consistency estimates were
above .90 (Mereish & Poteat, 2015; Scheer et al., 2020). Cronbach’s coefficient alpha for the
present sample was strong (α = .89).
Mental Health
Mental health, the main outcome variable of interest, was measured with the five-item
version of the Mental Health Inventory (MHI-5; Berwick et al., 1991). Participants responded to
questions about depression, anxiety, positive affect, and behavioral control over the last month.
The MHI-5 ranges from 1 (all of the time) to 6 (none of the time). The items indicating positive
affect are reverse scored. Higher scores indicate greater mental health. In a sample of SGM
community members where 32% identified as transgender, Cronbach’s alpha for the MHI-5
was .83 (Gonzalez et al., 2018). In the present study, the internal consistency was excellent (α
= .91).
Data cleaning, descriptive analyses, and assumption verification were conducted in R
Version 3.6.3. Latent variable SEM was executed with the R package lavaan 0.6-7 (Rosseel,
2020). Two latent variable models were constructed (Weston & Gore, 2006). First, the
measurement model used confirmatory factors analysis (CFA) to determine the relationship
between the latent constructs and the observed indicators. Second, the structural model tested the
hypothetical relationships among constructs. No covariates were included in the structural
model. The chi-square, comparative fit index (CFI), the root mean square error of approximation
(RMSEA), and the standardized root mean square residual (SRMR) indicated model fit. Given
the sample size (N < 500), goodness-of-fit guidelines for chi-square (nonsignificant), CFI (
.10), and SRMR (
.10) were used (Weston & Gore, 2006).
Descriptive Analyses and Assumption Testing
Table 1 shows descriptive statistics and bivariate correlations among measures.
Histograms, Q-Q plots, skewness (< |0.67|), and kurtosis (< |0.88|) provided evidence for
univariate normality (Weston & Gore, 2006), however the skew and kurtosis divided by their
standard errors revealed evidence of skew for ISOS (4.68), and kurtosis for GIMS (
PFQ2-Shame (
2.08), and MHI-5 (
2.84). Multivariate normality was assessed with the R
package MVN (Korkmaz et al., 2019). A chi-square Q-Q plot using Mahalanobis
evidence for multivariate normality, as did Mardia’s kurtosis (0.22, p = .825), but Mardia’s
skewness (78.45, p = .025) and Henze-Zirkler’s test (HZ = 1.06, p = .004) suggested multivariate
nonnormality. Ten multivariate outliers were identified using the quantile method (Korkmaz et
al., 2019). Given these moderate normality violations, maximum likelihood estimation with
robust standard errors was used (i.e., MLM; Rosseel, 2020; Weston & Gore, 2006).
Measurement Model
Individual CFAs were conducted to establish robust evidence for the measurement model
(Byrne, 2016) prior to fitting an overall measurement model (Weston & Gore, 2006) and the
results are presented in the Supplemental Materials. In cases where fit indices were suboptimal, a
“model generating” strategy was used to “locate the source of misfit in the model and to
determine a model that better describes the sample data” (Byrne, 2016, p. 8). That is, we
examined how the measurement model could be modified to improve fit to the data. Based on
individual CFAs, it was evident that: (a) the factor structure of the ISOS did not fit this sample,
so an exploratory factor analysis (EFA) was conducted, which yielded support for a four-factor
solution that was used in the overall measurement model; (b) modification indices showed that
allowing the error variances of four items on the TIS to covary improved model fit, so subscales
and individual items were used in the overall measurement model; and (c) individual MHI-5 and
PFQ2-Shame items were adequate indicators of mental health and feelings of shame. Subscales
were used as observable indicators for transgender microaggressions and self-objectification.
Similar to Brewster et al. (2019), a higher-order dehumanization factor was specified in the
overall measurement model from two latent variables: transgender microaggressions and sexual
objectification (see Figure 1).
The overall measurement model met assumptions of nonstandard CFA (Kline, 2015) and
exhibited somewhat inadequate fit, Satorra-Bentler corrected
(572) = 1,174.682, p < .001, CFI
= .893, RMSEA = .063 (90% CI [.058, .068]), SRMR = .076. Modification indices revealed that
the covariance between the error variances of the following items would improve the model fit
and be theoretically justifiable (Byrne, 2016; Kline, 2015): PFQ2-Shame items 7 and 10; PFQ2-
Shame items 8 and 9; and GIMS subscales 3 and 5. The respecified model yielded acceptable
model fit, Satorra-Bentler corrected
(569) = 1,130.203, p < .001, CFI = .90, RMSEA = .061
(90% CI [.056, .066]), SRMR = .075. This model did not differ from a model without the higher-
order factor,
(3) = 2.507, p = .474; however, it was significantly better than a model with
shame, self-objectification, and internalized transnegativity estimated as a second higher-order
(4) = 28.024, p < .001, as well as a model with only the internalization variables as a
single higher-order factor,
(3) = 26.211, p < .001. Neither a bifactor model with GIMS and
ISOS subscales as indicators of dehumanization,
(586) = 2,024.034, p < .001, CFI = .744,
RMSEA = .097 (90% CI [.090, .099]), SRMR = .222, nor a bifactor model with all variables
except for the MHI-5 items as indicators of dehumanization,
(564) = 1,548.169, p < .001, CFI
= .824, RMSEA = .082 (90% CI [.077, .087]), SRMR = .175, fit the data as well as the model
with the higher-order factor. Thus, for theoretical purposes, the model with the single
dehumanization factor was retained and H1 was supported.
Table 1 shows bivariate correlations among latent variables. As expected (H2a–d),
dehumanization as sexual objectification exhibited a moderate, positive relationship with
feelings of shame and self-objectification and a moderate, negative relationship with mental
health (for correlation benchmarks, see Cohen, 1992). Similarly, dehumanization as
microaggressions was positively correlated with feelings of shame (moderately) and internalized
transnegativity (weakly) and exhibited a moderate, negative correlation with mental health. In
terms of internalization processes (H3a–e): self-objectification was strongly, positively
associated with shame and moderately, negatively related to mental health; internalized
transnegativity was strongly, positively related to shame and strongly, negatively related to
mental health; and feelings of shame were strongly, negatively correlated with mental health.
Structural Model
In addition to correlations among latent factors, hypothesis testing derived from the
structural component of the SEM. The structural regression model yielded adequate fit to the
data, Satorra-Bentler corrected
(569) = 1,130.201, p < .001, CFI = .90, RMSEA = .061 (90%
CI [.056, .066]), SRMR = .075. As shown in Figure 1, the model explained a large proportion of
variance in all endogenous variables except for internalized transnegativity (
.36; Cohen,
1992): 36% in self-objectification, 62% in feelings of shame, and 55% in mental health.
Alternative structural models were tested (Kline, 2015). Given that self-objectification is
a distinct construct from internalized transnegativity (Fredrickson & Roberts, 1997; Israel et al.,
2020), a model without estimating the covariance of self-objectification and internalized
transnegativity yielded suboptimal goodness-of-fit and was inferior to the retained model,
= 45.158, p < .001. Since previous discrimination can influence perceptions of subsequent
discrimination (Meyer, 2003), internalization factors were reversed to predict dehumanization
and the model fit was equivalent to the retained model,
(569) = 1,130.201, p < .001, CFI = .90,
RMSEA = .061 (90% CI [.056, .066]), SRMR = .075, unless the covariance of self-
objectification and internalized transnegativity was omitted,
(570) = 1,130.114, p < .001, CFI
= .90, RMSEA = .061 (90% CI [.056, .066]), SRMR = .075. The model presented in Figure 1
was retained because theory should guide model selection, instead of reversing directional
predictions, when model equivalence is present (Thoemmes, 2015). Although (a) internalization
processes likely influence perceptions of subsequent dehumanization and (b) temporal
precedence was not established in this study, dehumanization precedes the internalization of
transnegativity, self-objectification, and shame theoretically (Bockting et al., 2013; Fredrickson
& Roberts, 1997; Moradi, 2013).
Figure 1 also shows the completely standardized path coefficients of all hypothesized
direct relations. When dehumanization was used as an exogenous variable, the direct paths to the
internalization processes were consistent with H2a–d: the direct relations between
dehumanization and internalized transnegativity, self-objectification, and shame were significant
and positive. Support for the internalization hypotheses was also evident: the direct path from
self-objectification to shame was significant and positive (H3a), the direct relations between
internalized transnegativity and the endogenous variables shame (H3c) and mental health (H3d)
were significant and in the hypothesized directions, and the direct relation between shame and
mental health was significant and negative (H3e). However, there was no significant direct
relation from self-objectification to mental health (H3b). Furthermore, contrary to H2d, the direct
path from dehumanization to mental health was not significant.
Indirect pathways were estimated using standardized coefficients (Kline, 2015; Rosseel,
2020) and are presented in Table 2. The indirect pathways from dehumanization to mental health
through self-objectification (H4b) and internalized transnegativity (H4c) were not significant.
However, H4a was supported: the pathway through shame was significant. Indirect pathways
from internalized transnegativity to mental health through shame (H5a) and from self-
objectification to mental health through shame (H5b) were significant. Since only the direct path
from internalized transnegativity to mental was significant, the total effect was estimated
(Rosseel, 2020). The total effect of internalized transnegativity on mental health through shame
was significant, β = –.48, SE = .07, 95% CI [–.62, –.34], p < .001.
This project extends the predictive power of Moradi’s (2013) pantheoretical
dehumanization framework by considering new, conceptually significant constructs. Three main
contributions are evident. First, the model explained 55% of the variance in transgender mental
health, suggesting that targeting microaggressions, sexual objectification, self-objectification,
internalized transnegativity, or shame in treatment has a reasonable chance of decreasing general
mental health concerns. Second, microaggressions overlapped with sexual objectification to
contribute significantly to the higher-order dehumanization factor (H1), as theorized in other
studies (Anzani et al., 2021; Flores et al., 2018; Moradi, 2013; Nadal et al., 2012), and thus
advances the pantheoretical model to be inclusive of microaggressions. Finally, seven of the nine
direct pathways postulated by the pantheoretical framework were supported, suggesting that
pantheoretical dehumanization warrants greater empirical attention in future SGM research.
Results provided support for most hypotheses and corroborated previous findings. The
dehumanization factor related directly to internalized transnegativity and self-objectification
(H2b, H2c), thereby supporting earlier work using the pantheoretical framework (Brewster et al.,
2019; Velez et al., 2016; Watson & Dispenza, 2015). The higher-order factor also directly
predicted general feelings of shame (H2a), which aligns with previous work (Nadal et al., 2011;
Watson & Dispenza, 2015). As expected, dehumanization evinced moderate-to-strong
correlations with all variables (H2a–d). The significant, moderate correlations (a) between
microaggressions and shame, (b) as well as among sexual objectification, shame, and self-
objectification, align with findings in cisgender samples (Fredrickson & Roberts, 1997; Moradi
& Huang, 2008; Nadal et al., 2011; Szymanski, 2020). In other words, this study suggests that
discrimination and objectification should be consider as concurrent stress processes among
transgender women and men because when everyday, covert indignities compound the distress
of being treated as a body part instead of a multidimensional person, transgender people are more
likely to appraise their gender identity negatively, objectify themselves, and feel shame.
With respect to other direct and indirect relations, aspects of the current model agreed
with previous findings. The significant direct paths from internalized transnegativity and self-
objectification to feelings of shame (H3a, H3c) have been observed in correlational studies
(Bockting et al., 2020; Fredrickson & Roberts, 1997; Moradi & Huang, 2008; Watson &
Dispenza, 2015). Further, the direct relations from internalized transnegativity and shame to
mental health (H3d, H3e) substantiate the adverse effects of both constructs (Bockting et al.,
2013; Mereish et al., 2019; Mereish & Poteat, 2015; Puckett & Levitt, 2015; Scheer et al., 2020).
The indirect pathway from dehumanization to mental health through feelings of shame was
significant (H4a), and the indirect relations from internalized transnegativity and self-
objectification to mental health through shame (H5a, H5b) emphasizes the importance of this
emotion (Mereish & Poteat, 2015; Scheer et al., 2020; Szymanski, 2020), especially in future
dehumanization research. Stated differently, our findings indicate that transgender people who
avoid perception as transgender or devalue their internal strengths tend towards feeling ashamed
which, in turn, exacerbates depressive and anxious symptoms while reducing positive affect.
Three departures from prior research were also evident. First, although the correlation
between microaggressions and mental health confirms earlier findings (Dyar et al., 2020; Nadal
et al., 2016), the higher-order factor was not directly predictive of mental health in the structural
model (H2d). One explanation for non-significance is the ongoing overt discrimination
experienced by the transgender community (Human Rights Campaign, 2020; Nadal et al., 2012)
which, in comparison to subtle expressions of hostility, may be a greater driver of mental health
disparities until more legal protections are enacted (Bradford et al., 2013). Future research should
include measures of overt, hostile, physical, and systemic discrimination as manifestations of
dehumanization. Another possibility is that the acute, common occurrence of transgender
microaggressions may evoke protective responses to mitigate the direct impact on mental health,
such as rationalizing the indignity or avoiding similar situations (Nadal et al., 2014). Indeed, the
present sample was drawn from affirmative online forums, so it is possible that participants had
greater coping resources to respond adaptively to microaggressions (Nadal et al., 2014, 2016). It
is also possible that the MHI-5, which was used traditionally as a screener (Berwick et al., 1991),
may not be sensitive to the domain of mental health influenced by microaggressions. Thus,
future studies should examine coping responses to delineate for whom dehumanization is most
problematic and use a more robust measure of mental health. Moreover, since data collection
occurred during COVID-19, a history effect may have been observed; perhaps social lockdown
reduced exposure to microaggressions in the present sample.
Second, since dehumanization was comprised of sexual objectification as well (H2d), the
nonsignificant direct association contrasts previous work with transgender (Brewster et al., 2019)
and cisgender (Jones & Griffiths, 2015; Moradi & Huang, 2008; Szymanski, 2020) samples.
Further, self-objectification demonstrated a nonsignificant positive trend (H3b). Brewster et al.
(2019) explained the positively trending, nonsignificant direct relation from dehumanization to
body dissatisfaction by noting how transgender women may interpret hypersexualization as
affirmations of gender identity, an observation reported in other work (Anzani et al., 2021).
Another explanation for the positive trend is that self-objectification may be a strategy for
transgender people to protect themselves from overt discrimination by emphasizing body
appearance to pass as cisgender (Flores et al., 2018). Indeed, monitoring the body to avoid
harassment has been suggested in a pantheoretical dehumanization study involving sexual
minority men (Watson & Dispenza, 2015). Accordingly, our results call for greater attention to
how SGM adults adapt to objectification to maintain safety or facilitate approval in a
dehumanizing environment.
Finally, the indirect relations between dehumanization and mental health through self-
objectification (H4b) and internalized transnegativity (H4c) were not significant. While the latter
was untested in previous work, the former contrasts research focusing solely on sexual
objectification (Jones & Griffiths, 2015). Lack of significant indirect effects is unsurprising
given that the direct effect of self-objectification was nonsignificant and the explained variance
of internalized transngeativity was small.
Implications for Practice, Advocacy, Education/Training, and Research
This is the first study to apply the pantheoretical dehumanization framework to general
mental health, calling for future research to test discrimination and objectification concurrently.
To our knowledge, it is also the first study to provide evidence linking transgender
microaggressions to internalized transnegativity. This association confirms previous work
indicating that microaggressions are minority stressors (Arayasirikul & Wilson, 2019; Balsam et
al., 2011; Nadal et al., 2016). Moreover, the significant direct and indirect pathways indicate the
application of pantheoretical dehumanization to phenomena beyond traditional objectification-
based mediators and outcomes (Brewster et al., 2019; Velez et al., 2016; Watson & Dispenza,
2015). That is, we found empirical support for microaggressions within the model which, before
the present investigation, was theoretical only (Moradi, 2013) or confirmed using a qualitative
approach (Flores et al., 2018). These novel contributions to the basic research on the targets of
transgender dehumanization are strengthened by a national sample, robust estimation procedures,
reliable measurement, and preregistration. However, the sample was comprised predominately of
transgender men assigned female at birth and data collection occurred during COVID-19, so
external validity of the present findings requires additional empirical support.
It is notable that shame had the strongest correlation with and direct relation to mental
health in this sample, thereby calling on future studies using pantheoretical dehumanization as
the conceptual core to consider general feelings of shame. Given the larger proportion of
variance explained in shame (62%) and significant indirect relations through shame, general
shame (versus traditionally examined body shame) may be a primary driver of poorer mental
health in transgender populations. Of course, this large proportion of explainable variance may
be contributed, in part, to the shame subscale of the TIS (Bockting et al., 2020). Nonetheless,
future research might use causal mediation analyses and daily diary studies to confirm these
pathways. It would be useful, for example, to determine if feelings of shame fully mediate the
pathway from internalized transnegativity to mental health.
Although a nonsignificant direct path from dehumanization to mental health was
surprising, the significant indirect relation from dehumanization to mental health through shame
indicates that discriminatory and objectifying processes are most detrimental to transgender
mental health when they “get under the skin” (Hatzenbuehler, 2009, p. 708). Taken together with
the significant indirect relations from internalization processes to mental health through shame,
this study suggests greater attention to intermediate reactions to dehumanization is warranted in
future research. Advocates and educators might challenge narratives that over-emphasize overt
forms of dehumanization by centering internal processes as important drivers of health inequity.
Several intervention and prevention implications with transgender clients can be drawn
from these results. First, results suggest that practitioners should address internalized
transnegativity. Interventions should illuminate the ways in which contextual dehumanization
contributes to negative affective arousal by fusing with self-appraisals about gender identity.
Clinicians might help clients develop a rational coping response to this internalized stigma
(Puckett & Levitt, 2015). For example, one might help the client accept phrases like “I feel
unhappy because people have treated me with less kindness, decency, and respect than I deserve,
not because I am transgender” or “I get lots of daily messages that being trans is not okay, so it
makes sense that my mind wants to believe that even though it is false.”
Second, Puckett and Levitt (2015) suggest the use of emotion-focused therapy with
gender minority clients. Given the significant influence of shame in the present study, targeting
this emotion with positive imagery, expressive enactment, or some other Gestalt principle may
be useful. For example, a clinician might encourage transgender clients to imagine a personal
hero or role model celebrating their gender identity or offering compassion for their
dehumanizing treatment. Scheer et al. (2020) suggested that group therapy could help to reduce
the health-depleting influence of shame, so referral to this modality may assist transgender
clients struggling with general mental health distress. That is, participating in a trans-specific
support group might help the transgender client recognize that they are not alone in their
struggles, which might increase self-acceptance and reduce feelings of embarrassment,
humiliation, and self-consciousness (i.e., aspects of shame; Harder & Zalma, 1990).
Finally, prevention should target microaggressions and sexual objectification in
community spaces. For example, behavioral health providers should advocate for transgender-
specific sexual harassment and discrimination policies within their institutions to prevent
environmental dehumanization and the internalization processes and affective responses that
flow from it.
Several limitations are evident. First, this study used a cross-sectional, correlational
design, so causality cannot be concluded. Relatedly, identical fit indices between the
measurement model and the retained structural model indicate that “no possibility exists of
unequivocally confirming” that the directional (structural) model is superior to the correlational
(measurement) model (Hershberger & Marcoulides, 2006, p. 38). Thus, future research is needed
to confirm or refute the evidence of directionality presented in this paper. We also found
equivalent structural models. Although theoretically informed model selection is appropriate in
this scenario (Thoemmes, 2015), these findings suggest that longitudinal designs are necessary to
advance theory-testing research on pantheoretical dehumanization. Our findings suggest that
internalization processes can be predicted by dehumanization and vice versa, which is
substantively useful: if internalized transnegativity, for instance, increases one’s sensitivity to
subsequent experiences of dehumanization, a compounding effect is probable. That is, even if
dehumanization precedes internalization as theorized (Moradi, 2013), internalization may
intensify subsequent experiences of sexual objectification and microaggressions. Future research
should test this plausible compounding effect.
Second, threats to external validity included (a) recruitment of transgender people who
participate in specific, trans-affirming online communities and (b) the lack of racial/ethnic
diversity. Third, participants may have deduced the aims of the study, choosing to comply or to
rebel, an issue of reactivity (Heppner et al., 2016). Fourth, the sample size, although
recommended by Weston and Gore (2006), may have limited the statistical power (Wolf et al.,
2013). Fifth, threats to construct validity may have occurred because the GIMS currently lacks
robust confirmatory evidence. However, it was the only measure of transgender
microaggressions at the time of study conception. Relatedly, scores on the SOBBS have not been
normed on transgender individuals, thus the factorial structure of scores may have been a
concern. Nonetheless, individual CFAs supported the factor structure of both measures.
Concerns about the construct validity of the ISOS should be considered as well, although the
follow-up EFA provided evidence for the factorial structure of the scores. Additionally, using
measures whose scores are normed on cisgender people is not ideal (e.g., ISOS), but it is
consistent with previous research with transgender adults (e.g., Velez et al., 2016).
A sixth limitation derives from using modification indices and nonstandard CFA models,
which although appropriate, may have introduce effects that are not replicable and sample-
dependent (Byrne, 2016; Kline, 2015). Finally, although Weston and Gore (2006) recommend
transforming or removing multivariate outliers, we retained them and used a robust estimation
procedure (i.e., MLM) which, while consistent with previous research (Brewster et al., 2019;
Velez et al., 2016), should be considered while interpreting the present findings. Moreover,
although we used Weston and Gore’s (2006) recommendations to evaluate model fit, stricter
thresholds exist (e.g., RMSEA
.05; Kline, 2015). Additional research would address these
limitations and expand the clinical utility of pantheoretical dehumanization.
In conclusion, dehumanization influences the mental health of transgender people
through internalization processes and shame, although more research is needed to confirm or
refute the pathways identified in this study. When working with transgender clients, clinicians
should target internalization processes and affective responses, most notably shame, to improve
mental health. Activists should attend to both discrimination and objectification in policy work.
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Table 1
Descriptive Statistics and Bivariate Correlations Among Latent Variables and Measures
Variable 1 2 3 4 5 6 7 M SD Range
1. Sexual objectification 53** 32** .01 .33** –.27** 2.14 0.75 1 – 4.6
2. Transgender microaggressions .61** .36** .10 .36** –.32** 7.0 3.52 0 – 14
3. Self-objectification .43** .52** .33** .50** –.35** 3.09 0.69 1.14 – 4.86
4. Internalized transnegativity .12 .14* .45** .47** –.46** 4.46 1.19 1.38 – 7
5. Feelings of shame .37** .45** .69** .60** –.66** 29.7 8.35 10 – 50
6. Mental health –.27** –.32** –.48** –.58** –.72** 17.6 5.69 5 – 30
7. Dehumanization .71** .86** .60** .16** .52** –.38** 2.14 0.75 1 – 4.6
Note. Latent variable correlations are below the diagonal; measurement-level correlations are above the diagonal. * p < .05 ** p < .001
Table 2
Indirect Relations of Study Variables
Predictor Mediator Criterion
Standardized Unstandardized
95% CI of
Indirect Relations
Dehumanization Internalized
transnegativiy Mental health –0.04 0.022 –0.044 0.024 –0.082 0.002
Dehumanization Self-objectification Mental health 0.044 0.073 0.048 0.079 –0.099 0.186
Dehumanization Shame Mental health –0.137* 0.055 –0.149 0.06 –0.244 –0.03
transnegativity Shame Mental health –0.232** 0.046 –0.222 0.044 –0.322 –0.142
Self-objectification Shame Mental health –0.209** 0.068 –0.342 0.12 –0.343 –0.075
* p < .05 ** p < .001
Figure 1
Structural Equation Model of Transgender Dehumanization and Mental Health
Note. A diagram of the structural regression depicting direct relations. Standardized coefficients (standard errors [SE]) are from a
completely standardized solution. The covariance of self-objectification and internalized transnegativity also was estimated (Ψ = .64,
SE = .09, p < .001), but omitted for clarity. * p < .05 ** p < .01 *** p < .001
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