While the term “gender” is often equated with the construct of biological sex, it actually refers to the socially constructed roles, behaviors, activities, and attributions that are the traditional norm for one’s assigned biological sex. Most current western societies only reference two genders (male and female); however, many societies since antiquity have had more (e.g., hijras, two-spirit). The term “transgender” is used as an umbrella term for those whose assigned biological sex is different from their gender identity. Alternately, the term “cisgender” commonly refers to a person whose gender identity and biological sex match.
Since its earliest conceptualization, the construct now known as gender dysphoria has been controversial. Early descriptions in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) stated that gender identity disorder “almost always” developed as a result of a problematic relationship with a parent or resulted from “extreme” or “prolonged” closeness to one’s mother during infancy. While much has changed since DSM-III, these historical conceptualizations of etiology have, in large part, resulted in a negative view of the field of psychology in the transgender community, making research with this community difficult. The little research that exists almost exclusively relies on local convenience samples, many of which use only those who have already transitioned or want to transition “full-time” (e.g., Testa et al., 2012). Yet, as our understanding of gender identity has evolved, so too has the concept of transgenderism.
Prevalence and Negative Effects of Sexual Violence
SexualVictimization. Transgender sexual victimization has only recently been attended to in the literature, which is very limited in scope. However, the research that does exist suggests that this population has a higher rate of victimization than the general population (Testa et al., 2012). These authors suggested prevalence rates of 24% for transgender women and 35% for transgender men. These are higher than sexual victimization statistics reported for the general public by Black et al. (2010) in their Centers for Disease Control and Prevention (CDC) report, which suggests prevalence rates of 18% and 1% for women and men, respectively.
Our recent study, including participants who identified as transgender (so as to be as inclusive as possible), found that transgender persons were 2.3 times more likely to be sexually victimized than their cisgender peers and 1.2 times more likely than cisgender lesbian, gay, and bisexual (LGB) people (Fraine, Pawlow, Pomerantz, & Pettibone, 2018). These same data revealed that 87% of transgender participants reported a sexual victimization event, significantly higher than the 74% reported by their cisgender and 84% of LGB peers.
Transgender survivors of sexual victimization overwhelmingly report that they believe their victimization was due to their gender identity or expression (Testa et al., 2012). In fact, it has been reported that simply exhibiting gender nonconforming behaviors is a risk factor for violence against transgender individuals (Lombardi, Wilchins, Priessing, & Malouf, 2001). Not only are transgender individuals more likely to experience victimization, but transgender survivors are also more likely to suffer from mental health issues correlated with victimization experiences like drug and alcohol abuse (Testa et al., 2012). Previous research has suggested that transgender survivors of sexual victimization are also more likely to attempt suicide than those who have not experience sexual victimization (Xavier, Bobbin, Singer, & Budd, 2005; Clements-Nolle, Marx, & Katz, 2006).
Revictimization.Another well-documented issue that plagues many survivors of sexual victimization is revictimization. Multiple victimizations compound the risk for mental health issues such as Posttraumatic Stress Disorder (PTSD) and dissociation, and a recent meta-analysis of the general population suggests that 48% of survivors go on to be revictimized (Walker, Freud, Ellis, Fraine, & Wilson, 2017).
Our study was, to our knowledge, the first to explore revictimization in the transgender population, finding that transgender persons were 1.6 times more likely to experience revictimization than their cisgender peers and were only slightly less likely than LGB persons. Our data suggest that 82% of transgender victims were be revictimized. This rate was significantly higher than the 68% reported by cisgender participants in the study.
Mental Health and Help-Seeking.
Greater risk for mental illness has been well established within the broader LGBT community. Comorbidity, for example, has been shown to be 4 times higher in the LGB population (Spengler & Ægisdóttir, 2015). However, this is does NOT suggest that being LGBT causesmental illness; instead, it suggests that issues like prejudice, discrimination, and internalized stigma due to our heterosexist society play a vital role in the mental health of sexual and gender minorities (Meyer, 2003).
Sexual minorities have been shown to seek help from mental health providers at higher rates than heterosexuals, even if there is no current presenting issue (Rutter et al., 2016). However, those who experience sexual violence tend to seek help at lower rates (Thompson, Sitterle, Clay, & Kingree, 2007). Conjointly, recent research has found that sexual minorities who have experienced sexual violence sought help at significantly lower rates than heterosexuals who have also experienced sexual violence (Richardson, Armstrong, Hines, & Reed, 2015).
Our study also looked at attitudes toward psychological services. We compared cisgender, sexual minority, and transgender survivors and non-survivors of sexual trauma. While past research suggested that transgender and LGB survivors view psychological services less favorably, this was not the case in our sample. In fact, while the attitudes of non-survivors were still more favorable overall, transgender survivor attitudes were not significantly lower than non-survivors and were not significantly different from cisgender survivor attitudes. This suggests that transgender survivors may potentially be viewing psychological services more positively than they had in the past and/or that they may be currently more likely to seek help after their victimization than was historically the case.
Resilience theory argues that resilience is a combination of both personal attributes and the complex transactions with a person in their environment (Gitterman & Germain, 2008). As such, resilience has been widely accepted as a protective factor against mental illness. While the literature has been growing over the last decade, we have been unable to locate any research to date that has compared resilience across transgender, sexual minorities, and cisgender groups.
We found that transgender participants, regardless of victimization status, scored significantly lower on a popular measure of resilience, suggesting that transgender individuals may be less resilient than their cisgender peers. Meyer’s minority stress theory should be kept in mind;internalized stigma, social prejudice, and discrimination may hinder a person’s resilience. With all of this associateddistress, it may be difficult for transgender survivors of sexual victimization to remain hopeful and optimistic, factors which are associated with resilience (Kwon, 2013).
Our data paint both a bleak and a hopeful picture for members of the transgender community. On the one-hand, sexual victimization rates in this sample were astonishingly high, higher than in previous reports. To our knowledge, we were the first to report revictimization data for this population and those numbers were exceedingly high as well. Finally, this community may be less resilient in the face of trauma than their cisgender counterparts. This could be, at least in part, due to other stressors that transgender survivors face daily. However, on the positive side, our data suggest that this population may be more open to seeking help for mental health issues related to sexual victimization than they have been in the past.
The “me too” movement has drawn considerableattention to sexual victimization in the past year and recent political events have caused many survivors to relive their traumatic experience. While we continue to explore sexual victimization in an attempt to help our clients and participants, it is critical that gender minorities be included in the conversation.
Black, M. C., Basile, K. C. Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., Chen, J., & Stevens, M. R. (2010).The national intimate partner and sexual violence survey (NISVS): 2010 summary report.Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality,51, 53 – 69.
Fraine, S. F., Pawlow, L. C., Pomerantz, A. M., & Pettibone, J. C. (2018). Sexual Victimization of the Transgender Population(Master’s thesis). Retrieved from ProQuest Disstertations and Theses database. (UMI No. 10750694)
Gitterman, A., & Germain, C. B. (2008). The life model of social work practice(3rded.). New York, NY: Columbia University Press.
Kwon, P. (2013). Resilience in lesbian, gay, bisexual individuals. Personality and Social Psychology Review, 17(4), 371 – 383.
Lombardi, E. L., Wilchins, R. A., Priessing, D., & Malouf, D. (2001). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42, 89 – 101.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129,674 – 697.
Richardson, H. B., Armstrong, J. L., Hines, D. A., & Reed, K. M. P. (2015). Sexual violence and help-seeking among LGBQ and heterosexual college students. Partner Abuse, 6(1), 29 – 46.
Rutter, T. M., Flentje, A., Dilley, J. W., Barakat, S., Liu, N. H., Gross, M. S., Muñoz, R. F., &
Leykin, Y. (2016). Sexual orientation and treatment-seeking for depression in a multilingual worldwide sample. Journal of Affective Disorders, 206,87 – 93.
Spengler, E. S. & Ægisdóttir, S. (2015). Psychological help-seeking attitudes and intentions of lesbian, gay, and bisexual individuals: The roles of sexual minority identity and perceived counselor sexual prejudice. Psychology of Sexual Orientation and Gender Diversity, 2(4), 482 – 491.
Testa, R. J., Sciacca, L. M., Wang, F., Hendricks, M. L., Goldblum, P., Bradford, J., & Bongar, B. (2012). Effects of violence on transgender people. Professional Psychology: Research and Practice¸43(5), 452 – 459.
Thompson, M., Sitterle, D., Clay, G., & Kingree, J. (2007). Reasons for not reporting victimizations to the police: Do they vary for physical and sexual incidents? Journal of American College Health, 55(5), 277 – 282.
Walker, H. E., Freud, J. S., Ellis, R. A., Fraine, S. F., & Wilson, L. C. (2017). The prevalence of sexual revictimization: A meta-analytic review. Trauma, Violence, & Abuse, 1 – 14.
Xavier, J., Bobbin, M., Singer, B., & Budd, E. (2005). A needs assessment of transgendered people of color living in Washington, D. C. International Journal of Transgenderism, 8,31 – 47.
Shawn Fraine recently earned an M.A. in Clinical Psychology from Southern Illinois University Edwardsville and is now the project coordinator of the SPAN lab at Washington University in St Louis. His research interests include sexual health and relationships within the LGBTQ+ community, sexual trauma, and factors that contribute to the prevention of revictimization. Shawn will be applying to Ph.D. programs for Fall 2019.