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Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals

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Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals Transgender Health Volume 1.1, 2016 Transgender DOI: 10.1089/trgh.2016.0012 Health ORIGINAL ARTICLE Open Access Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals Brian A. Rood,1,* Sari L. Reisner,2–4 Francisco I. Surace,5 Jae A. Puckett,6 Meredith R. Maroney,7 and David W. Pantalone3,5 Abstract Purpose: Transgender and gender-nonconforming (TGNC) individuals often are the target of enacted or exter- nal (i.e., distal) experiences of stigma, discrimination, and violence, which are linked to adverse health, particularly psychological distress. There is limited research, however, examining felt or internal (i.e., proximal) stressors faced by TGNC individuals. This study sought to examine one type of internal stressor, expecting rejection, and aimed to (1) identify how and to what extent rejection expectations operate day-to-day for TGNC individuals and (2) ex- plore how TGNC individuals respond to expectations of rejection. Methods: In-depth interviews were conducted with 30 participants from 2014 to 2015 who identified as TGNC (mean age = 30.4; 60% people of color); data were analyzed using a consensual qualitative research method. Results: Four thematic categories emerged about expecting rejection: (1) where to expect rejection; (2) thoughts and feelings associated with expectations of rejection; (3) coping strategies used to manage the expec- tation of rejection; and (4) the intersection of race and ethnicity with rejection expectations. Conclusion: Findings from this study suggest that expecting rejection is a frequent and salient internal stressor for TGNC individuals. We discuss the psychological and cumulative potential health impact of minority stress, and the applicability of Meyer’s Minority Stress Model. Therapeutic interventions are needed to address the specific cognitive, emotional, and behavioral responses TGNC individuals experience as a result of the stress associated with expecting rejection, including fear, anxiety, and situational avoidance. Keywords: expecting rejection; gender; minority stress; stigma; transgender Introduction Prevalence estimates of discrimination among TGNC Transgender and gender nonconforming (TGNC) indi- individuals are shown to be extraordinarily high, ex- viduals have a current gender identity or expression that ceeding 60% in several published studies.5,6 Similarly, differs from their assigned sex at birth. Although re- estimates for victimization are commonly greater search investigations that focus specifically on the health than 40% for TGNC people.7,8 Emerging research and well-being of TGNC individuals remain limited, also has highlighted an association between enacted peer-reviewed published articles have documented the stressors and indicators of negative mental and physi- pervasiveness with which TGNC people face enacted ex- cal health. For example, TGNC individuals who periences of stigma, discrimination, and victimization.1–4 reported having experienced physical or sexual abuse, 1Department of Psychology, Augsburg College, Minneapolis, Minnesota. 2Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts. 3The Fenway Institute, Fenway Health, Boston, Massachusetts. 4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 5Department of Psychology, University of Massachusetts, Boston, Massachusetts. 6Department of Psychology, University of South Dakota, Vermillion, South Dakota. 7Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts. *Address correspondence to: Brian Rood, PhD, MPH, Department of Psychology, Augsburg College, 2211 Riverside Avenue, Minneapolis, MN 55454, E-mail: [email protected] ª Brian A. Rood et al. 2016; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. 151 Rood, et al.; Transgender Health 2016, 1.1 152 http://online.liebertpub.com/doi/10.1089/trgh.2016.0012 compared to those who did not, are significantly more Gamarel et al. examined relationship stigma—real or likely to report a history of suicidal ideation and suicide anticipated feelings of negative judgment from others attempts.9,10 Likewise, experiences of gender-related dis- as a result of one’s romantic relationship being socially crimination are shown to be significantly associated with devalued—among couples comprising cisgender men elevated levels of psychological distress for TGNC indi- and transgender women.21 They found that higher levels viduals.11 Thus, enacted stressors appear to be detrimen- of reported relationship stigma were associated with in- tal to the health of TGNC individuals and continued creased odds (adjusted odds ratio = 1.13) of reporting and ongoing research, particularly longitudinal studies clinically significant depressive distress.21 examining the relationship of such stressors to health Thus, there is support for the notion that TGNC in- over time, is needed. dividuals might expect rejection specific to their gender Enacted stressors, however, represent only the external identity, and preliminary data appear to support an as- processes and experiences faced by TGNC individuals. sociation between expecting rejection and psychologi- TGNC individuals likely experience internal stressors cal distress.11 However, the internal experience of and processes in response to these and other external expecting rejection is not well understood. Specifically, stressors. Consistent with the theory and empirical we do not know how TGNC individuals perceive and research underlying Meyer’s Minority Stress Model, assign meaning to this expectation and how they re- internal or proximal stressors are considered more sub- spond emotionally. Examining the internal process jective and related to self-identity.12–15 According to through which TGNC individuals might expect rejec- the model, the three specific proximal stressors recog- tion would offer a more informed perspective regard- nized are as follows: (1) identity concealment, (2) inter- ing the noted association between experiences of nalized stigma, and (3) expectations of rejection. stigma and adverse mental health, including implica- Expecting rejection—the focus of the present tions for future points of therapeutic intervention. article—is described in the literature as a form of felt Two recently published studies have also investigated stigma, which is understood as an individual’s knowl- variations of expecting rejection among TGNC individu- edge of society’s stance toward nonmajority individu- als. In one study, investigators examined specific situa- als, and expectations regarding the likelihood of tions or environments that TGNC individuals might stigma being enacted in a given situation as a result avoid, based on the fear of being outed against their of having a minority status, for example, for sexual wishes. With a sample of 889 TGNC individuals, 38.8% and gender minority individuals.16 Notably, research reported avoiding public restrooms, 38.4% reported has demonstrated that having a dual minority status avoiding gyms, 29.8% reported avoiding clothing shops, (e.g., being a person of color who is also a sexual minor- and 24.0% reported avoiding public transportation.22 ity) can further complicate and heighten experiences of Although these findings are helpful in identifying situa- enacted stigma, which has implications for expecting tions where TGNC individuals may expect rejection, rejection, especially among individuals who represent they do not describe why or how the expectation more than one marginalized identity.17 might manifest, or how TGNC individuals may respond There is a moderate amount of published data to to the perceived threat. Increasing knowledge in this show how expecting rejection operates in the lives of area would aid researchers in identifying how to target cisgender (i.e., nontransgender or someone whose gen- and effectively address areas perceived as unsafe (e.g., der identity matches what is typically associated with through stigma reduction interventions). someone of their sex assigned at birth) sexual minority In the second study, investigators examined the as- individuals.18–20 Yet, published research that demon- sociation between employment status, coping strate- strates how expecting rejection is experienced by gies, and internalized transphobia and transgender TGNC individuals remains scarce. stigma among 55 TGNC individuals.23 The sample Based on a review of the extant literature, only a few consisted of 24 transgender women (male-to-female), published studies have empirically investigated how 20 transgender men (female-to-male), seven genderqu- expecting rejection might operate in the lives of TGNC eer or gender fluid individuals (who do not situate individuals. Bockting et al. surveyed 1,093 transgender in- themselves within the gender binary), and four individ- dividuals and found that the expectation of rejection (i.e., uals who were either undecided or did not indicate felt stigma) was positively associated with psychological their gender. The study demonstrated that higher levels distress, and negatively associated with levels of outness.11 of effective coping strategies (e.g., coping with work- Rood, et al.; Transgender Health 2016, 1.1 153 http://online.liebertpub.com/doi/10.1089/trgh.2016.0012
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