Body image, interoceptive awareness, depression and eating disorder symptoms: Within-group variability among sexual minority women.

This study investigates within-group differences in body image concerns among sexual minority women and their related association with eating disorders and depression. Cross-sectional data were collected in 2017 and analysed in 2020 from 201 sexual minority women in the United States. Latent profile analyses and post hoc comparison analyses were conducted to investigate within-group variability in body image concerns and to understand their impact on depressive and eating disorder symptoms. Results suggested that a 5-class solution best fit the data, with five distinct profiles emerging in patterns of interoceptive awareness, sociocultural attitudes toward appearance, body shame, body surveillance and appearance anxiety. Significant differences in mean scores of depressive and eating disorder symptomatology emerged among the profiles; groups that reported low interoceptive awareness and high body image concerns experienced greater levels of eating disorder and depressive symptoms, compared to groups with average or higher levels of interoceptive awareness and average or lower body image concerns. Results underscore the significant within-group variability that exists for sexual minority women with regard to the prevalence of body image concerns, depressive symptoms and eating disorder symptoms. Efforts that aim to increase interoceptive awareness (for example, mindfulness) alongside strategies aimed at addressing negative body image concerns may be particularly effective avenues for future depression and eating disorder prevention in this diverse group. Our reporting adheres to the STROBE research reporting checklist.

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Factors that drive mental health disparities and promote well-being in transgender and nonbinary people.

Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions.

A Dangerous Visibility: Moderating Effects of Antitrans Legislative Efforts on Trans and Gender-Diverse Mental Health.

The present study used a minority stress theory framework to investigate the direct and indirect relations of minority stressors (transgender discrimination experiences, internalized transphobia, identity nondisclosure), sense of belonging, and hopelessness with depression and anxiety symptoms in a sample of 301 trans and gender-diverse adults living in the United States. This study also explored the moderating effect of having knowledge of antitrans legislative efforts in one's state of residence on the overall pattern of results through a nested model comparison of the hypothesized path analysis. Participants were recruited using Internet-based forums, listservs, and social media, and survey data were collected online. Significant moderation effects were found, such that for those who reported having knowledge of antitrans legislative efforts in their state of residence reported a stronger association of external stressors (discrimination) than internal stressors (internalized transphobia, identity nondisclosure) on sense of belonging and hopelessness than their peers who did not have any knowledge of such legislative efforts. Furthermore, hopelessness emerged as a stronger predictor for those who were aware of antitrans legislative efforts. Implications of study findings for counseling, advocacy, and future research are discussed.

Variability in eating disorder risk and diagnosis in transgender and gender diverse college students.

PURPOSE: To examine differences in elevated eating disorder risk and self-reported eating disorder diagnosis across subgroups of transgender and gender diverse (TGD) college students. METHODS: Data from 5057 TGD college students participating in the national Healthy Minds Study between 2014 and 2019 were analyzed. Chi-square tests and logistic regression analyses examined heterogeneity in prevalence and odds of elevated eating disorder risk, as measured by the SCOFF, and self-reported eating disorder diagnosis by gender, as well as by intersecting gender and sexual orientation identities. RESULTS: Genderqueer and/or non-conforming college students reported the highest prevalence of elevated eating disorder risk (38.8%) relative to gender expansive students. Genderqueer and/or non-conforming (11.1%), gender expansive (12.3%), and trans men and/or transmasculine students (10.5%) reported higher prevalence of a self-reported eating disorder diagnosis relative to trans women and/or transfeminine students (6.3%). Heterosexual or straight trans men had lower odds of eating disorder risk and self-reported diagnosis relative to trans men with a minoritized sexual orientation. CONCLUSIONS: Genderqueer and/or non-conforming college students may be at heightened eating disorder risk. Moreover, a heterosexual and/or straight sexual orientation was associated with lower odds of elevated eating disorder risk and self-reported eating disorder diagnoses among trans men and genderqueer and/or non-conforming college students, but this finding did not hold for other groups. College campuses should aim to reduce eating disorder risk among TGD students.

Policy attitudes toward adolescents transitioning gender.

Anti-transgender policies and state legislative initiatives that focus on school bathroom use and hormone use have emerged in recent years. These policies are generally written by and voted on by cisgender people, and as such, it is crucial to understand influences on nonaffirming attitudes toward policies that can impact trans youth. The present study aimed to extend research on transphobic attitudes in general to attitudes toward policies that impact youth undergoing transition. Latent variable covariances and structural equation modeling were used to test the relations between transphobia, genderism, homophobia, need for closure, sexual orientation, social dominance orientation, attitudes toward sexual minorities, beliefs about gender roles, aggression, religious fundamentalism, and contact with sexual and gender minority individuals, as they are related to attitudes toward hormone use and bathroom use for trans youth. Analyses of data from a sample of 248 cisgender adults indicated that genderism and transphobia was associated with attitudes toward gender-affirming hormone use and bathroom use for trans youth; need for closure was associated with gender-affirming attitudes toward bathroom use, but was not associated with hormone use. Sexual orientation was linked to attitudes toward gender-affirming policies, such that nonheterosexual participants had more affirming attitudes toward trans youths' bathroom use, but not hormone use. Implications for future research, advocacy efforts to promote rights for trans youth, and clinical work with trans youth and/or parents/guardians of trans youth are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Impact of Mental Health Care Provider Website Transgender and Nonbinary Affirmation on Site User Experience for Transgender/Nonbinary and Cisgender People.

Transgender and gender nonbinary (TGNB) individuals use provider information, such as websites, to ascertain whether providers are affirming of TGNB identities. Yet, providers may be unsure about what level of affirmation is sufficient to be perceived as affirming and may be concerned that cisgender people may have negative reactions to website material that is TGNB affirming. The present study undertook a user experience (UX) investigation of TGNB and cisgender participants' UX of mental health provider websites. Participants (310 cisgender, 224 TGNB) were recruited online. Participants viewed one of five mock provider websites. Results of a multivariate analysis of covariance (MANCOVA) indicated that TGNB had more positive evaluations of the three more affirming sites, compared to the less affirming sites, along UX domains related to likelihood of going to that provider, Mental Health Help-Seeking Attitudes, positive emotional UX, and negative emotional UX. Regardless of gender identity, participants rated the three more affirming sites as more welcoming. The results support the use of TGNB affirmation in the UX of TGNB individuals viewing provider websites and further suggest that TGNB affirmation does not detract from the UX of cisgender people. Implications for affirming practice with TGNB populations are reviewed.

The development of an observational coding scheme to assess transgender and nonbinary clients' reported minority stress experiences.

Trans and nonbinary individuals experience high rates of identity-based stigma and stress (minority stress) in U.S. society. Despite research empirically linking minority stress with adverse mental health outcomes, the extent to which minority stress experiences are discussed in psychotherapy and how therapists respond is unknown. The primary aim of the present study was to develop and test an observational coding scheme, the Minority Stress Experiences and Interactions (MSEI) scheme. With this scheme, observational data from psychotherapy sessions with 19 transgender and nonbinary adult psychotherapy client participants were coded to provide pilot data for the initial development of the MSEI coding scheme. A total of 19 clients' entire 50-min psychotherapy sessions were coded over 3 phases of psychotherapy: beginning (Session 1), middle (Session 2), and end (Session 10/11). Results indicate that the MSEI scheme was reliable for most codes. Codes revealed that all (N = 19; 100%) clients in the study reported at least 1 minority stress event (MSE) over the course of the 3 sessions, with the mean number of MSEs being 7 per client. The most frequent proximal stressor reported by clients was related to internalized stigma and the most frequent distal stressor reported by clients was prejudice. A total of 2 clients' clinical exchanges with their therapists centered on MSEs are highlighted to demonstrate the nuance of how MSEs are discussed in session, specifically regarding multiple minority identities. Implications for the current study include the need for therapist training regarding minority stress interventions and attention to power and oppression within sessions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and psychometric evaluation of the Sexual Minority Women's Sexual Objectification Experiences Scale.

Research has linked experiences of sexual objectification to body image and eating problems among women. Existing measures of sexual objectification were grounded in heterosexual women's experiences. The present research extends this prior work by centering sexual minority women's experiences to develop and evaluate the Sexual Minority Women's Sexual Objectification Experiences Scale (SMW-SOE). In Study 1, an initial 51 items were developed, drawing on prior qualitative research with sexual minority women and existing measures of sexual objectification experiences. Exploratory factor analysis of 217 sexual minority women's responses to the initial item set suggested an underlying structure of three interrelated factors. In Study 2, data were collected from an independent sample of 201 sexual minority women to conduct confirmatory factor analysis and evaluate validity evidence. Findings from the confirmatory factor analysis supported a higher order solution with three first-order factors. The final scale comprised 17 items: six items assessing Sexualization of Sexual Identity, five items assessing Intrusive and Explicit Sexual Advances, and six items assessing Body Evaluation. In terms of validity, SMW-SOE overall scale scores yielded expected small-to-large positive correlations with heterosexist experiences, internalization of sociocultural appearance standards, and disordered eating; SMW-SOE subscale scores yielded distinctive patterns of correlations. SMW-SOE scale and subscale items yielded acceptable Cronbach's alphas in both samples. Implications for future research and clinical work are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Inhospitable World: Exploring a Model of Objectification Theory With Trans Women.

In this study, we investigated key tenets of objectification theory, a prominent model of body image disturbance, as it relates to trans women's disordered eating and intention to obtain silicone injections-a specific health risk for this population. We also incorporated appearance congruence, or the degree to which an individual personally feels that their gender expression matches their gender identity, into the objectification theory model. Results of a structural equation model using data from a sample of 173 trans women from the United States indicated that the basic objectification theory model held among this sample and that appearance congruence was associated negatively with body surveillance. However, appearance congruence did not have significant direct or indirect links (via body surveillance and body shame) with disordered eating or intention to obtain silicone injections. Thus, disordered eating and intention to obtain silicone injections are potential negative outcomes of the process of objectification among trans women, and appearance congruence does not appear to be uniquely linked to health risks associated with internalization of cultural standards of attractiveness, body surveillance, and body shame. Our findings support the application of the tenets of objectification theory with trans women as they apply to disordered eating and intention to obtain silicone injections and also indicate the need to identify other positive influences on trans women's body image to counteract internalization of cultural standards of attractiveness.

Objectification of sexual minority women: Responses, consequences, and resistance.

This study investigates responses to, consequences of, and resistance against objectification from the perspectives of sexual minority women in the United States. Data from 5 focus groups with 33 sexual minority women were analyzed using thematic analysis. Results revealed 13 themes and 49 subthemes. First, sexual minority women's responses to objectification included those described in prior research with heterosexual women, as well as novel responses not routinely assessed in prior research (e.g., critical examination), and the complex co-occurrence of responses (e.g., indignation and internalization). Second, participants identified deleterious consequences that were consistent with prior theory and research as well as consequences that reflected resilience and growth from working through objectification. Finally, participants articulated personal, relational, and identity-related forms of resistance against objectification. Sexual and gender identity processes were interwoven with resistance. These results highlight how centering sexual minority women's experiences can both corroborate and advance prior understanding of responses to and consequences of objectification. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Work and well-being in TGNC adults: The moderating effect of workplace protections.

The present study used a psychology of working theory (PWT) framework to test the direct and indirect relations of perceived social status and transgender and gender nonconforming (TGNC) marginalization (i.e., victimization, nonaffirmation of gender identity, negative expectations for the future) with work volition, overqualification, and vocational and emotional well-being outcomes (i.e., job satisfaction, meaningful work, satisfaction with life, depression) in a sample of 175 TGNC working adults. This study also tested the moderating effect of one form of structural marginalization (lack of legal protections from employment discrimination) on the overall pattern of results. Participants were recruited using online social media and discussion forums and completed the study survey online. For the full sample, perceived social status and nonaffirmation of gender identity were associated with vocational and emotional well-being outcomes through the mediating role of work volition, and for some paths, overqualification. Significant differences emerged in the overall pattern of results for those without protections, suggesting that protections from discrimination buffer the adverse links of some forms of TGNC marginalization with work volition and vocational outcomes. Implications of study findings for research, counseling, and advocacy are provided. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

"I don't care about you as a person": Sexual minority women objectified.

This study investigates sexual minority women's experiences of objectification in the United States. Data from 5 focus groups with 33 sexual minority women were analyzed using thematic analysis (Braun & Clarke, 2006, 2012). Results revealed 6 themes and 34 subthemes grouped into "manifestations of objectification: general and explicit intersections," "immediate context of relational and situational characteristics," and "broader context of oppression and privilege along gender and sexualities." First, sexual minority women's experiences of objectification included both general manifestations described in prior research with heterosexual women and manifestations of objectification that reflected intersections of systems of inequality based on sexual orientation, gender identity, race, ethnicity, culture, and age. Second, participants identified novel relational and situational characteristics of objectification. Finally, participants included experiences of stereotyping, discrimination, and dehumanization in their conceptualizations of objectification, connecting their experiences of objectification with broader dynamics of power related to gender and sexuality. Centralizing sexual minority women's experiences, this study produced a fuller understanding of objectification experiences in general and of sexual minority women's experiences in particular. (PsycINFO Database Record

Suicide risk in trans populations: An application of minority stress theory.

Drawing on minority stress theory, the present study tested the relations of minority stressors (i.e., experiences of prejudice and discrimination, internalized antitrans attitudes, fear of antitrans stigma), social support (i.e., friend, family, and significant other support), and substance use (i.e., drug and alcohol use) with depression and suicide risk in a sample of trans individuals. Depression was examined as a mediator of the relations of minority stressors and social support with suicide risk; drug and alcohol use were examined as direct correlates of suicide risk. Participants were 335 trans-identified individuals, diverse in gender identities (e.g., trans men, trans women, nonbinary gender identities). They were recruited using online social networks and they completed the study survey online via Qualtrics. Structural equation modeling was used to test hypothesized relations. Depression fully mediated the relations of perceived experiences of discrimination, fear of antitrans stigma, and friend support with suicide risk, and partially mediated the relation of internalized antitrans attitudes with suicide. Drug use was positively associated with suicide risk, whereas alcohol use was not linked with suicide risk. Exploratory comparisons across gender subgroups suggested that the pattern of relations among study variables was consistent across trans men, trans women, and individuals with nonbinary gender identities. These findings point to minority stressors, friend support, and drug use as potentially fruitful targets of prevention and intervention efforts to reduce depression and suicide risk in trans populations. (PsycINFO Database Record

Revised and abbreviated forms of the Genderism and Transphobia Scale: tools for assessing anti-trans prejudice.

Many studies of anti-trans prejudice have measured such attitudes using the Genderism and Transphobia Scale (GTS; Hill & Willoughby, 2005). The GTS is unique in assessing negative attitudes and propensity for violence toward trans people. The present research addressed previously observed limitations in the psychometric properties of data produced by the GTS, including inconsistencies in factor structure and subscale scoring across studies. Results across the present 2 studies (Ns = 314 and 250) yielded 2 refined versions of the GTS: the 22-item GTS-Revised (GTS-R) and a more abbreviated 13-item GTS-R-Short Form (GTS-R-SF), each of which produced stable 2-factor structures corresponding with the intended negative attitudes and propensity for violence dimensions of the GTS. The 2 versions differ in that the GTS-R-SF Genderism/Transphobia subscale focuses on more severe expressions of prejudicial attitudes, whereas the longer GTS-R Genderism/Transphobia subscale assesses subtle expressions of prejudice as well. The Gender-Bashing subscale is identical across the 2 versions. Thus, researchers and practitioners may choose the GTS-R or GTS-R-SF depending on the breadth of prejudicial attitudes they wish to assess. Reliability estimates for GTS-R and GTS-R-SF scale and subscale item responses were acceptable and stable across the 2 studies, and validity evidence was garnered in Study 2. These findings can inform use of the GTS-R and GTS-R-SF in research and practice settings, where psychometric precision and efficiency are both critical.