THE DEVELOPMENT AND PSYCHOMETRIC EVALUATION OF THE TRANSGENDER CONGRUENCE SCALE DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Holly B. Kozee, M.A. ***** The Ohio State University 2008 Dissertation Committee: Approved by Nancy E. Betz, Advisor Tracy L. Tylka _________________________________ Pamela S. Highlen Advisor Graduate Program in Psychology ii ABSTRACT The present study proposed that the concept of congruence (Rogers, 1959) could be useful way to conceptualize the process of transitioning in the transgender population. Congruence, as it is related to transgender persons, is defined as the degree to which a transgender individual feels that their gender identity, physical appearance and social status match with each other. When a transgender individual has attained an optimal level of congruence, the psychic distress that they previously experienced due to their gender identity, sometimes called gender dysphoria, is dampened. A scale called the Transgender Congruence Scale was constructed to measure the construct of congruence in the transgender population. An exploratory factor analysis revealed that the scale possesses three factors: appearance congruence, body comfort and gender identity pride. Evidence of the internal consistency reliability, construct validity, convergent validity and discriminant validity of the scale’s scores was garnered. ii Dedicated to Binx iii ACKNOWLEDGMENTS I wish to thank my advisor, Dr. Tylka, for being an amazing mentor, both personally and professionally and for always providing me with the support that I’ve needed. I would also like to thank for my amazing faculty, Dr. Betz, Dr. Highlen and Dr. Dell for putting so much energy into giving me such an amazing and rich graduate education and clinical training, despite all of the I wish to thank my parents, for giving me unlimited support and patience, for instilling in me the desire to always be a learner and for loving me no matter what silly thing I do. I’d also like to thank the other people in my graduate cohort, Erica, Casey, Danice, Tiffany, Melissa, Chad and PJ. You have become my family these past five years and I’ve learned so much from each of you. I hope that all of you will always be in my life. I’d also like to acknowledge my fellow interns at UT-Austin, Sylvia, Javier, Joan, Jim, Maya, Jeremy and Irina. I feel so incredibly lucky to have had each of you in my life this year; thank you so much for becoming my Austin family. iv Thanks to Matthew for helping me to come up with names for the factors and for drinking lots of coffee with me while I wrote most of this. I’d also like to acknowledge all of the amazing members of the GLBT and transgender communities throughout the country who have been so gracious in helping me to find participants for the study by placing my advertisement on their website, dispersing it to their listserv and sending it along to others that they know. Finally, I’d like to thank all of the transfolk who took the time out to participate in this study. I hope that this study can be used to help create a more accepting and trans- friendly world. Thank you so much for your help! v VITA May 17, 1981. Born – Canton, Ohio 2004. ………..M.A, Psychology, The Ohio State University. 2003 – 2004. ..Graduate Research Associate. The Ohio State University. 2004 - 2005. Graduate Administrative Assistant The Ohio State University. 2005 - 2007. Graduate Teaching Assistant The Ohio State University. 2007 - 2008. Pre-doctoral Psychology Intern The University of Texas-Austin. PUBLICATIONS Research Publications 1. Rodebaugh, H. & Kozee, H.B. (2007). Coping and Vicarious Traumatization in Women Psychologists, Perspectives . 2. Kozee, H.B., Tylka, T.L., Denchik, R.B. & Augustus-Horvath, C. (2007). The Development and Validation of the Interpersonal Sexual Objectification Scale, Psychology of Women Quarterly, 31(2 ), 176-189. 3. Kozee, H.B., Tylka, T.L. (2006). A Test of Objectification Theory with Lesbian Women, Psychology of Women Quarterly, 30(4 ), 348-357. vi FIELDS OF STUDY Major Field: Psychology vii TABLE OF CONTENTS P a g e Abstract. ii Dedication. .iii Acknowledgments . ...iv Vita . .vi List of Tables. ix Chapters: 1. Introduction……………………………………………………………………….1 1.1 Overview……………………………………………………………………...1 1.2 Differentiating Gender Roles and Gender Identity…………………………...2 1.3 Categories of Transgender Identity…………………………………………...3 1.4 Models of Transgenderism. ……………………………………......................5 1.4.1 The Transsexual Model…………………………………………......6 1.4.2 Transgender Model…………………………………………………9 1.4.3 Models of Transgenderism and Empirical Research………….......12 1.5 Congruence……………………………………………………………….....12 2. Literature Review……………………………………………………………..…15 2.1 Overview…………………………………………………………………….15 2.2 Psychosocial Adjustment of the Transgender Population...............................15 2.3 Psychological Impact of the Sexual Reassignment Surgery...........................25 2.4 Summary of Empirical Research....................................................................37 2.5 Purpose of Study.............................................................................................40 viii 2.6 Psychometrics..................................................................................................41 2.6.1 Test Construction.............................................................................41 2.6.2 Test Reliability.................................................................................43 2.6.2.1 Test-Retest Reliability......................................................43 2.6.2.2 Internal Consistency Reliability.......................................44 2.6.3 Test Validity.....................................................................................44 2.6.3.1 Content Validity...............................................................44 2.6.3.2 Criterion-Related Validity................................................45 2.6.3.3 Construct Validity............................................................46 2.6.3.4 Convergent Validity.........................................................48 2.6.3.5 Discriminant Validity.......................................................49 2.7 Research Questions.........................................................................................49 3. Methods………………………………………………………………….............51 3.1 Participants......................................................................................................51 3.2 Procedure.........................................................................................................54 3.3 Instruments......................................................................................................54 3.3.1 Congruence......................................................................................55 3.3.2 Meaning in Life................................................................................56 3.3.3 Satisfaction with Life.......................................................................57 3.3.4 Body Dissatisfaction........................................................................58 3.3.5 Anxiety.............................................................................................59 3.3.6 Depression........................................................................................60 3.3.7 Steps to Transition...........................................................................61 3.3.8 Socially Desirable Responding........................................................61 3.3.9 Demographic Questionnaire............................................................62 3.4 Ordering of Instruments..................................................................................62 3.5 Design..............................................................................................................63 4. Data Analysis………………………………………………………………....…65 4.1 Exploratory Factor Analyses...........................................................................65 4.2 Internal Consistency Reliability......................................................................77 4.3 Validity Evidence............................................................................................77 4.3.1 Additional construct validity evidence.............................................80 4.3.2 Convergent validity evidence...........................................................82 4.3.3 Discriminant validity evidence.........................................................82 5. Discussion……………………………………………………………………….83 5.1 Overview.........................................................................................................83 5.2 Discussion of findings from Exploratory Factor Analysis..............................83 5.3 Discussion of Scale’s Reliability Evidence.....................................................84 5.4 Discussion of Scale’s Validity Evidence.........................................................85 ix 5.4.1 Discussion of Scale’s Construct Validity........................................85 5.4.1.1 Congruence and Satisfaction with Life............................85 5.4.1.2 Congruence and Meaning in Life.....................................87 5.4.1.3 Congruence and Body Dissatisfaction..............................89 5.4.1.4Congruence and Depression..............................................90 5.4.1.5 Congruence and Anxiety..................................................91