City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 9-2018 Beyond the Binary: Gender Identity and Mental Health Among Transgender and Gender Non-Conforming Adults Chassitty N. Fiani The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/2815 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] BEYOND THE BINARY: GENDER IDENTITY AND MENTAL HEALTH AMONG TRANSGENDER AND GENDER NON-CONFORMING ADULTS by CHASSITTY N. FIANI A dissertation submitted to the Graduate Faculty in Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2018 © 2018 CHASSITTY N. FIANI All Rights Reserved ii Beyond the Binary: Gender Identity and Mental Health among Transgender and Gender Non- Conforming Adults by Chassitty N. Fiani This manuscript has been read and accepted for the Graduate Faculty in Psychology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. __________________ __________________________________ Date Kevin L. Nadal Chair of Examining Committee __________________ __________________________________ Date Richard Bodnar Executive Officer Supervisory Committee: Dr. Chitra Raghavan Dr. Brett Stoudt Dr. Michelle Fine Dr. David Rivera THE CITY UNIVERSITY OF NEW YORK iii ABSTRACT Beyond the Binary: Gender Identity and Mental Health among Transgender and Gender Non- Conforming Adults by Chassitty N. Fiani Advisor: Kevin L. Nadal Despite increasing endorsement of non-binary gender identities among TGNC (transgender or gender non-conforming) populations, research regarding TGNC experiences often over- emphasizes pathology relative to positive psychology and reinforces binary conceptualizations of gender (exclusively male/female). TGNC individuals face increased rates of depression, suicide risk, anxiety, substance abuse, HIV/AIDS, homelessness, victimization, and negative police interactions. These disparities are exacerbated by discrimination, lack of culturally competent resources, and internalized stigma. Despite these negative experiences and increased risks, TGNC individuals hesitate to seek treatment and/or police assistance due to fears of discrimination, cultural incompetence, and/or re-victimization. To address these gaps, the present investigation utilized a mixed-methods design with a sample of 357 self-identified TGNC adults. Study 1 included individual interviews whereas Study 2 included an online survey. Both segments collected socio-demographic and mental health data. Overall, seven hypotheses were investigated: 1) Participant narratives will indicate a greater degree of heterogeneity in later phases of identity development than previously considered; 2) Narratives will reveal common themes of risk (e.g., internalized or environmental stigma) and resiliency (e.g., social support, community connectedness) within developmental processes; 3) Victimization will positively predict depression, anxiety, gender dysphoria, and grit; 4) Victimization will negatively predict iv flourishing; 5) Social support will mediate the relationship between victimization and psychological well-being; 6) TGNC community connectedness will mediate the relationship between victimization and psychological well-being; 7) Victimization will relate to decreased help-seeking (mental health or criminal justice services). v Contributors and Funding Sources This work was supported by an internal dissertation committee consisting of Dr. Kevin L. Nadal (chair), Dr. Chitra Raghavan (committee member), and Dr. Brett Stoudt (committee member) of the City University of New York (CUNY) Graduate Center, John Jay College Psychology Department. Internal committee members contributed to initial revisions to Chapters 1-3, comprising the Second Doctoral Exam and Dissertation Proposal. In addition, this work was supported by two external committee members: Dr. Michelle Fine and Dr. David Rivera. All work conducted for the dissertation was completed by the student independently. Graduate study was supported by the Five-Year Graduate Center Fellowship of the CUNY Graduate Center. Compensation for interview study participants (in the amount of $50 each) was supported by the Ohio Psychological Association’s Michael Sullivan Diversity Scholarship and by the FPRI grant issued by the Forensic Psychology Research Institute (FPRI) at John Jay College. vi Table of Contents ABSTRACT ................................................................................................................................... iv Chapter 1: Introduction to the Study.......................................................................................... 1 Defining Gender Identity ......................................................................................................... 2 Gender Identity Research ........................................................................................................ 4 TGNC health disparities. ........................................................................................................ 5 Victimization and resilience. .................................................................................................. 7 Departing the Gender Binary .................................................................................................. 8 Summary and Present Investigation ....................................................................................... 8 Chapter 2: Literature Review .................................................................................................... 10 Defining Gender and Gender Identity .................................................................................. 11 Multiculturalism and Gender Identity. .................................................................................. 15 Defining Identity ..................................................................................................................... 17 Identity “stages” versus “statuses”........................................................................................ 19 Multicultural Identity Development Models ........................................................................ 20 History of Gender Identity Research .................................................................................... 23 Intersections of gender identity and sex assigned at birth. ................................................... 25 TGNC Identity Development ................................................................................................. 29 Alternative Models of TGNC Identity Development ........................................................... 37 Departing the Binary .............................................................................................................. 40 Gender non-conforming children. ......................................................................................... 44 Gender non-conforming adolescents and adults. .................................................................. 47 Prevailing Assumptions .......................................................................................................... 48 vii Gender, Diagnostics and Stigmatization ............................................................................... 50 Gender Variance and Clinical Cultural Competence.......................................................... 55 Current guidelines. ................................................................................................................ 57 Gender Dysphoria Treatment ................................................................................................ 66 TGNC Mental Health Disparities .......................................................................................... 69 Other Disparities Contributing to Mental Health ............................................................... 71 Theoretical Approaches to Disparity Origins ...................................................................... 74 Minority Stress Theory. ........................................................................................................ 74 Social Justice Theory. ........................................................................................................... 77 Microaggression Theory. ...................................................................................................... 83 Gender Identity, Discrimination and Mental Health .......................................................... 86 Victimization and the TGNC Community ............................................................................ 88 “Victims” versus “survivors”. ............................................................................................... 90 Beyond the Deficit Skew in TGNC Research ....................................................................... 91 Resilience and the TGNC community. ................................................................................. 93 Summary and the Present Investigation ............................................................................... 95 Chapter 3: Methods .................................................................................................................