Eating disorders among queer and trans individuals: Implications for conceptualization, assessment, and treatment.

Eating disorders (EDs) have been traditionally viewed as a disorder affecting cisgender, heterosexual women. Yet, the prevalence of EDs among queer and trans (QnT) individuals, coupled with the lack of interventions that attend to contextual factors related to sexual orientation and gender identity, underscore a critical health disparity issue requiring urgent attention. Here, we first review factors pertaining to QnT individuals' minoritized sexual and gender identities that are important to consider in ED conceptualization for this population (e.g., minority stressors, identity-based body image standards). Next, we describe problematic assumptions present in existing ED assessment and propose more inclusive approaches. Lastly, we provide suggestions for practices that providers can implement within their treatment of EDs among QnT individuals.

Resisting Trans Medicalization: Body Satisfaction and Social Contextual Factors as Predictors of Sexual Experiences among Trans Feminine and Nonbinary Individuals.

Past research has constructed a medicalized model of trans women's sexuality, where trans women are believed to be hyposexual and distressed by their bodies pre-transition, and are cured of their sexual dysfunction as a result of gender affirmative medical procedures. The current study engaged a community sample (N = 169) of trans feminine and nonbinary individuals assigned male at birth (TFNB) to investigate predictors of sexual experiences after addressing methodological biases of prior studies, including body satisfaction (using a modified Body Image Scale) and social contextual factors. Hierarchical regressions were conducted to test the hypothesis that after accounting for demographic variables and social contextual aspects (i.e., body satisfaction, social dysphoria, and fetishization), medical transition (i.e., hormone therapy) would not significantly predict five outcomes of sexual experience (i.e., receptive penetration, insertive penetration, importance of sex, sexual pleasure, and sexual intimacy). Across all models, medical transition was not a significant predictor of sexual experiences; however, sexual orientation, age, body satisfaction, and experiences of fetishization were frequent predictors. Results suggest that the sexual experiences of TFNB individuals do not align with the medicalized model and that demographic and contextual factors play an important role in the sexual outcomes for this population.

Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals.

Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.

Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress.

Ruminative thought patterns, defined as repetitive negative self-focused attention, are considered an avoidant coping strategy for managing stress. As trans and nonbinary (TNB) individuals commonly experience prejudice and discrimination in response to their gender identities (i.e. minority stressors), rumination over these stressors may contribute to heightened risk of psychopathology in these groups. Although rumination is a general risk factor for eating disorder (ED) psychopathology, no studies to date have examined whether eating- or gender-related ruminative patterns relate to maintenance of ED psychopathology for TNB individuals. This cross-sectional study investigated whether levels of rumination (both gender-related and ED-specific) mediated the relationship between minority stress and ED psychopathology. METHOD: Participants were 242 TNB adults (Mage = 24.92, SD = 6.5, Range = 18-70) recruited online, who completed measures of minority stress, gender-related rumination, ED-specific rumination, and ED psychopathology. We used Preacher-Hayes' approach to examine the parallel mediation model, with gender-related and ED-specific rumination as potential mediators. RESULTS: Gender-related rumination did not mediate the relation between gender minority stress and ED psychopathology, Indirect B = -0.00 [95% BCa CI: -0.01, 0.00]; however, ED-specific rumination was significant, indicating partial mediation, Indirect B = 0.01 [95% BCa CI: 0.00, 0.02]. CONCLUSION: As gender minority stress and ED-specific rumination relate to ED psychopathology, it is essential that clinicians adopt an intersectional minority stress framework in understanding ED psychopathology among TNB individuals.

"There Is Nothing to Do About It": Nonbinary Individuals' Experience of Gender Dysphoria.

Purpose: Clinical definitions of gender dysphoria have primarily centered on a binary conceptualization of gender. This study aimed to understand nonbinary transindividuals' experiences of gender dysphoria. Methods: Data were collected online from a nonclinical sample comprised of 205 nonbinary and agender participants. Analysis focused on answers to a single open-ended question prompting participants to describe their gender dysphoria as it relates to their body and/or appearance. Results: First, content analysis was used to document 11 contextual elements in which participants described their dysphoria with regard to three overarching categories, including no gender dysphoria (no issues with body, no dysphoria), aspects of gender/sex (naming gender identity, naming assigned sex, gender role, or expression), and aspects of body (body shape, genitals, chest, secondary sex characteristics, hormones, reproductive capability). Second, thematic analysis revealed six central themes describing the unique way gender dysphoria is experienced by nonbinary individuals: (1) Androgyny or Fluidity, (2) Feminine and Masculine Traits, (3) Dysphoria vs. Expression or Appearance, (4) Varying or Shifting Dysphoria, (5) No Solution, and (6) Trade-off/Loss. Conclusion: Results of this study suggest that nonbinary transindividuals experience gender dysphoria in unique ways. These findings highlight the need to develop clinical assessments of gender dysphoria that reflect nonbinary experience, and to outline explicit medical protocols for interventions tailored to achieve a desired outcome of physical androgyny.

Using a Comprehensive Proximal Stress Model to Predict Alcohol Use.

Purpose: The gender minority stress model has been proposed by researchers to explain the high rates of substance use found within transgender communities, but its explanatory power has never been directly tested. Further, qualitative research has noted that premedically transitioned and nonbinary individuals are more likely to engage in avoidant coping such as drinking to cope. As such, the current study tested the relationship between proximal stress (comprised of internalized transphobia, anticipated stigma, concealment, and gender dysphoria), drinking to cope, and problematic alcohol use. Methods: Transgender and nonbinary participants over the age of 18 (N=297) completed an online survey on alcohol use. To test for differences in drinking to cope across gender identity and medical transition, analysis of variance and independent t-tests were conducted. Further, a structural equation model of proximal stress was developed to test whether drinking to cope mediated the relationship between proximal stress and alcohol use. Results: There were no significant differences across gender identity or medical transition status in severity of drinking to cope. Proximal stress was significantly related to problematic alcohol use and the relationship was explained by an indirect relationship with drinking to cope. Conclusion: Findings from this study suggest that drinking to cope is an important aspect of high rates of alcohol use found in the transgender community. Implications for clinical practice with transgender individuals are discussed.

Brooding Over the Closet: Differentiating Sexual Orientation Rumination and Sexual Orientation Obsessions.

Two concepts that describe repetitive thoughts regarding an individual's sexual orientation-sexual orientation rumination and sexual orientation obsessions-have been introduced into the research literature. Despite the fact that these concepts have similarities, important distinctions exist with regard to their theoretical underpinnings, development, and catalyst of stress. As these concepts have never been teased apart in the research literature, understanding how these concepts are similar and different is particularly important. To this end, the present overview synthesizes the current literature regarding these concepts with the purpose of providing a decisional framework for differentiating sexual orientation rumination and sexual orientation obsessions and suggesting areas of future research.

"Having a non-normative body for me is about survival": Androgynous body ideal among trans and nonbinary individuals.

The present study focused on trans and nonbinary (TNB) individuals who have an androgynous or non-stereotypical body ideal, with attention to how their body ideal is conceptualized and maintained. Data were collected online from 76 TNB individuals. Based on responses to two open-ended prompts, a two-tiered analysis was conducted. First, thematic analysis was used to develop four central themes describing the way TNB individuals conceptualized their androgynous body ideal: 1) Attaining Neutrality and De-Categorizing Gender; 2) Disaggregating Gender Expression; 3) Managing Gender Dysphoria; and 4) Achieving Authenticity. Second, content analysis was used to document 12 behaviors engaged in or actions taken for the purpose of approaching or maintaining an androgynous or non-stereotypical body ideal. These were grouped into 3 main categories: gender expression (clothes, hair, make-up, body modifications), body shape (weight, muscularity, eating/diet), and sex characteristics (hormone therapy, body hair, vocal, chest, genitals). Results of the present study expand the current body ideal literature by including TNB narratives and by focusing specifically on the ways an androgynous body ideal is conceptualized and maintained. Research and clinical implications are discussed.

"Being Talked to Like I Was a Sex Toy, Like Being Transgender Was Simply for the Enjoyment of Someone Else": Fetishization and Sexualization of Transgender and Nonbinary Individuals.

Despite the growing interest in the experiences of transgender individuals, the phenomenon of fetishization of transgender bodies and identities has been overlooked. The present study was aimed at investigating the experiences of fetishization of transgender and nonbinary (TGNB) people. Participants in the current study represent a sample of 142 TGNB volunteers from the community who answered the prompt: "If you feel comfortable, could you describe your experience of being fetishized?" Using thematic analysis, we developed three overarching themes relevant to the experiences of fetishization of TGNB participants: (1) context of fetishization; (2) negative experiences of fetishization; and (3) positive or ambiguous experiences of fetishization. The results demonstrated that, in most cases, fetishization was understood by TGNB people as a negative experience of sexual objectification, although some individuals experienced fetishization as a positive experience, perceiving the sexual desire of the other person or living it as a kink. Consistent with the integrated theory of dehumanization, the results demonstrated that both sexual objectification and minority stress contributed to participants' understanding of fetishization for TGNB individuals. Implications for clinical work with TGNB individuals are discussed.

Sexual Satisfaction in Trans Masculine and Nonbinary Individuals: A Qualitative Investigation.

The present study investigated the ways trans masculine and nonbinary individuals describe aspects of their sexual satisfaction. Sexual satisfaction refers to an individual's subjective evaluation of their sexual experiences, and is influenced by relational, contextual, and personal experiences. Prior research with sexual satisfaction among trans individuals utilized quantitative measures, restricting the ability for respondents to describe trans-related aspects. Further, the pervasive focus on the effects of medical transition on binary trans individuals' experiences in prior research limits our understanding of those who do not desire a medical transition or live outside of the gender binary. Participants represented a community sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you satisfied with your sex life?" Thematic analysis revealed eight overarching themes that represented two categories: universal and trans-related. Discussion focuses on the ways in which clinicians and researchers can utilize the current findings to improve the sexual satisfaction of trans masculine and nonbinary individuals.

Body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals.

BACKGROUND: Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards. PURPOSE: This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. METHODS: Participants (n = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology RESULTS: Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology CONCLUSION: Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals' gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

What Constitutes Sexual Dissatisfaction for Trans Masculine and Nonbinary Individuals: A Qualitative Study.

The present study is aimed at understanding how trans masculine and nonbinary individuals describe aspects of their sexual dissatisfaction. Previous studies on cisgender sexual dissatisfaction have utilized narrow definitions of dissatisfaction, operationalizing it in opposition to sexual satisfaction. Moreover, the pervasive focus on the outcomes of medical intervention steps in prior sexual dissatisfaction research with trans masculine participants ignored the experiences of individuals who do not desire a medical transition or live outside of the gender binary. Participants in the current study represented a non-clinical sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you dissatisfied with your sex life?" Thematic analysis revealed six overarching themes for participant dissatisfaction: 1) difficulty with orgasm, 2) partner dynamics, 3) trauma, 4) desire for different body parts, 5) gender dysphoria, and 6) medical transition. Discussion focuses on the ways in which clinicians can utilize the current findings to decrease the sexual dissatisfaction of trans masculine and nonbinary individuals.

Subjective Ratings of Gender Dysphoria Scales by Transgender Individuals.

The present research explored transgender individuals' subjective ratings of two clinical measures of gender dysphoria: the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) and the Utrecht Gender Dysphoria Scale (UGDS). Participants read each scale and provided a global rating regarding how well they captured their experiences of gender dysphoria. Participants included 622 transgender individuals who identified as transfeminine (n = 221), transmasculine (n = 206), and non-binary/agender (n = 195). Findings indicated clear patterns of responses across gender identity and assigned sex, but not clinical diagnosis. For the GIDYQ-AA, transfeminine and transmasculine individuals rated the scales more positively than did non-binary/agender individuals. In addition, participants who were assigned male rated the scale to be a more accurate measure of their dysphoria than did participants who were assigned female. For the UGDS, transfeminine individuals rated the scale most positively, followed by transmasculine individuals, and then non-binary/agender individuals. All pairwise comparisons were significant. Likewise, participants who were assigned male rated the scale to be a more accurate measure than did those who were assigned female. It is important to note that subjective ratings were relatively low (M = 3.40, SD = 1.09 for GIDYQ-AA; M = 3.43, SD = 1.22 for UGDS on a 5-point scale) where little more than half of the participants (52.5% GIDYQ-AA; 54% UGDS) agreed or strongly agreed that the scales captured their experience. Discussion focused on the implications for using these measures of gender dysphoria in both clinical and research settings.

"I love you as both and I love you as neither": Romantic partners' affirmations of nonbinary trans individuals.

Background: Transgender microaffirmations are subtle endorsements of a person's gender identity through both verbal acknowledgements and behavioral gestures. Microaffirmations positively impact individuals who identify as transgender by acknowledging their gender identity and by communicating a sense of support and validation. Aims: This study focuses on microaffirmations specifically directed toward nonbinary transgender individuals within romantic relationships. Methods: Participants included 161 adults who identified as nonbinary: 85 who identified as gender nonconforming and 76 who identified as agender. These participants were either currently in a romantic relationship or had been in a romantic relationship within the past 5 years. Participants completed an online survey and provided examples of the microaffirmations they experienced from their romantic partners. Results: Responses were analyzed via thematic analysis, resulting in four overarching themes: (1) Identity Validations, acknowledgement and acceptance of nonbinary identity; (2) Identity Endorsements, active endorsements of nonbinary through language or behavior; (3) Active Learning, self-education about nonbinary identities; and (4) Active Defense, interruptions of others' negative actions directed at nonbinary partners. Discussion: Discussion of the results focuses on understanding how microaffirmations operate to complicate binary notions of gender/sex and positively influence nonbinary transgender individuals in interpersonal relationships.

Assessing Experiences With LGBT Microaggressions in the Workplace: Development and Validation of the Microaggression Experiences at Work Scale.

LGBT people experience microaggressions in the workplace; however, limited research exists in this area partly due to a lack of psychometrically sound instruments measuring the prevalence of LGBT microaggressions in the workplace. To address this gap, an empirical study was conducted and the LGBT-MEWS was created and tested. The LGBT-MEWS is a 27-item self-report scale comprising three subscales. Each subscale conceptually represents a different domain through which microaggressions impact LGBT employees: (1) workplace values, (2) heteronormative assumptions, and (3) cisnormative culture. The results of testing indicated that the subscales demonstrate strong reliability and validity.

The Role of Forensic Factors and Potential Harm to the Child in the Decision Not to Act Among Men Sexually Attracted to Children.

To date, sexual abuse prevention efforts have largely focused on tertiary prevention strategies designed to prevent recidivism among forensic samples of men with a history of sex offending behavior. The present study used mixed methodology to investigate the role of several forensic and related factors on the decision not to commit a sex offense among two groups of community men who self-reported a sexual attraction to children: those who reported a history of acting on their attractions (Acted, n = 29) and those who reported never acting on their attractions (Not Acted, n = 71). Participants from both groups described in their own words the factors that contributed to their decision not to act on their attractions. They also responded to quantitative and qualitative questions regarding the influence and role of the following factors on their decision not to act: (a) the possibility of jail or punishment, (b) mental health treatment, and (c) not wanting to hurt the child. Results were compared across groups, and across prompted and unprompted responses. Analyses highlighted harm to the child as a particularly salient factor in the decision not to act among men in the community at risk for sexually offending. The present study suggests that investigating potential protective factors may be an important direction for future research among samples of community men at risk for both first-time and repeat offenses against children.

The Perceived Role of General Self-Regulation and Prosocial Support on the Decision Not to Act Among Men Sexually Attracted to Children.

Recent research highlights potential differences between groups of men sexually attracted to children regarding child molestation behavior, attitudes toward sex with children, and the decision not to act on their attractions. The present study furthered this line of research by investigating the roles of general self-regulation and prosocial support on the decision not to act among 69 men sexually attracted to children. Mixed-methods analysis of survey results provided mixed evidence regarding their relevance to refraining from engaging in child molestation behavior. Quantitative results suggested that self-control, but not prosocial support, showed a major influence on participants' decision not to act. Qualitative results offered a more nuanced understanding of the roles of both of these factors in participants' decisions. Overall, findings support an approach for investigating men sexually attracted to children that focuses on differences between men who do and do not act on their attractions, as well as on the active decision to refrain from engaging in child molestation behavior. Implications for research and clinical practice are highlighted.

Face Validity Ratings of Sexual Orientation Scales by Sexual Minority Adults: Effects of Sexual Orientation and Gender Identity.

The present research explored sexual minority individuals' ratings of two traditional (Kinsey and Klein Sexual Orientation Grid [KSOG]) and two novel (Sexual-Romantic and Gender Inclusive) sexual orientation scales with regard to how well they capture their sexuality. Participants included 363 sexual minority individuals who identified as lesbian, gay, bisexual, pansexual, or queer, and included individuals who identified as transgender (n = 85) and cisgender (n = 278). The findings indicated clear patterns of responses across both sexual orientation and gender identity, where participants differed in the degree to which they felt the scales captured their sexuality. A main effect of sexual orientation was found for all four scales, where participants endorsing monosexual (lesbian/gay) identities rated the scales more positively than did participants endorsing plurisexual (bisexual and pansexual/queer) identities. Bisexual individuals had a unique pattern of ratings, which sometimes aligned with those of lesbian/gay participants and sometimes aligned with pansexual/queer participants. A main effect of gender identity was found for the Kinsey, KSOG, and Sexual-Romantic (but not Gender Inclusive) scales, where cisgender individuals rated the scales more positively than did transgender individuals. There were no significant interaction effects between sexual orientation and gender identity for any of the four scales. The present findings can be used to understand sexual minority individuals' assessment of the face validity of four sexual orientation measures. Discussion focused on the implications for using traditional measures of sexual orientation in research as well as for the development of new measures that better capture the range of sexual minority experience.