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

Physical Activity, Anxiety, Depression, and Body Image in Trans Individuals: An Exploratory Study

Physical activity (PA), mental health, and body image are some important health topics in the transgender population that have been recently discussed and appear to play a crucial role in the quality of life of the trans population. This study aims to elucidate the complex interplay of these variables and their implications for the well-being of trans individuals.

METHODS

In a cross-sectional study, 75 Portuguese transgender individuals (M = 23.68; SD ± 6.59) were recruited to participate in this study. The participants completed three questionnaires related to the assessment of physical activity (IPAQ), depressive and anxious symptomatology (HADS), and satisfaction with body image (BISQp).

RESULTS

Trans individuals showed a total energy expenditure of 3316.40 metabolic equivalent tasks (METS), had a moderate level of anxiety symptomatology, and low levels of satisfaction with body image. Satisfaction with body image was negatively associated with anxiety (r = -0.441, p < 0.01) and depression symptomatology (r = -0.600, p < 0.01).

CONCLUSIONS

The implementation of inclusive programs that promote body acceptance and coping strategies, particularly within the context of physical exercise, may help alleviate distress related to body image dissatisfaction while also addressing underlying anxiety and depression symptoms.

Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study

BACKGROUND

Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance.

AIMS

The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety.

METHOD

A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants' gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality.

RESULTS

Among TGD young people, gender dysphoria was significantly positively associated with suicidality (β = 0.15, 95% CI = 0.11-0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (β = 0.07, 95% CI = 0.05-0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality.

CONCLUSIONS

Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.

Transgender body image: Weight dissatisfaction, objectification & identity - Complex interplay explored via matched group

In the context of body image and mental health, transgender individuals face distinctive challenges stemming from the complexities of their gender identity journey, societal expectations, and body norms. However, the existing line of research on this topic remains limited. This study explores the complex relationship in transgender individuals between body objectification, body weight dissatisfaction, and eating concerns. A sample of 154 individuals (77 transgenders paired with 77 cisgenders) was recruited via LGBTQ+ groups' mailing lists. Participants completed various questionnaires assessing body image, eating psychopathology, depression, and body objectification. Propensity score matching was performed with different variables: age, current BMI, years of education, current self-identified gender, and sexual orientation. The results revealed that transgender individuals experienced higher levels of body objectification, body weight dissatisfaction, and eating concerns compared to their cisgender counterparts. Additionally, age emerged as a protective factor, as older transgender individuals demonstrated improved body acceptance and self-esteem. Logistic regression analyzes indicated that bulimic behaviors, depressive symptoms, and appearance control beliefs were specific factors significantly associated with being transgender. Our findings highlight the unique challenges faced by transgender individuals in navigating their gender identity and body image, underscoring the importance of targeted interventions and support systems.

A scoping review of the research literature on eating and body image for transgender and nonbinary adults

BACKGROUND

Eating disorder treatment approaches and outcome studies have historically centered almost exclusively on cisgender populations. Transgender and nonbinary (TGNB) adults are underrepresented in general and intervention research despite being at increased risk for eating and body image-related problems.

AIMS

This scoping review was designed to gather and examine the research with TGNB adults who experience eating and body image related problems, as well as clinical studies on the effectiveness of treatment approaches.

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used for reporting this review. MEDLINE and PsychInfo were used as electronic databases for searching subject terms. Inclusion criteria for studies required the quantitative measurement or qualitative exploration of body image or eating for TGNB adults. The relevant data were extracted and summarized based on quantitative findings and qualitative themes.

RESULTS

After review of over 1258 articles, 59 studies met criteria and data were extracted and summarized. Factors associated with eating disorders and body image problems across studies suggests gender-affirming medical interventions are effective and emphasized treatment for an eating disorder is warranted alongside gender affirming medical care. Body image was associated with eating patterns aimed at meeting gendered ideals of body shape and size. There was variation in guiding theories and absence of consensus in the definition of transgender in the review studies. This likely demonstrates the changing language, social acceptance of TGNB people and identities, diagnostic criteria, and clinical conceptualizations of eating and body image.

CONCLUSIONS

Future research should consider the use of theory for guiding inclusion of salient social factors influencing eating patterns, body image, and treatment outcomes. In addition, future research is needed that centers on nonbinary and genderqueer populations, as well as those from minoritized racial and ethnic groups to inform culturally appropriate concerns, needs, and treatment modalities.

Factorial Invariance of Scores on the Self-Objectification Beliefs and Behaviors Scale (SOBBS) Among Transgender and Nonbinary People

The dimensionality and factorial invariance of scores on the Self-Objectification Beliefs and Behaviors Scale (SOBBS) were examined with a sample of 590 transgender and nonbinary participants. Results failed to disconfirm the two-factor model and provided adequate estimates of internal consistency reliability. Strong, strict, and structural invariance of scores were observed.

Help-seeking and challenges faced by transwomen following exposure to gender-based violence; a qualitative study in the Greater Kampala Metropolitan Area, Uganda

BACKGROUND

The high prevalence of gender-based violence (GBV) among transwomen is a human rights and public health challenge. Nonetheless, there is limited evidence of sources of GBV support services and the challenges faced by transwomen while help-seeking, especially in transphobic settings like Uganda. This study explored the sources of GBV support services and the challenges faced by transwomen in the Greater Kampala Metropolitan Area during help-seeking.

METHODS

A qualitative study design involving 60 transwomen and 10 key informants was conducted. Respondents were recruited using snowball sampling. An in-depth interview (IDI), and a focus group discussion guide were used to collect data from 20 IDI respondents and six focus group discussants. Each focus group discussion averaged six participants. A key informant interview guide was used for key informant interviews. Data were transcribed verbatim and analysed following a thematic framework, informed by the socio-ecological model. Data were organised into themes and subthemes using NVivo 12.0.

RESULTS

The sources of support following exposure to GBV included key population-friendly healthcare facilities and civil society organisations (CSOs), and friends and family. Friends and family provided emotional support while key population-friendly healthcare facilities offered medical services including HIV post-exposure prophylaxis. Key population CSOs provided shelter, nutritional support, and legal advice to GBV victims. Lack of recognition of transgender identity; long distances to healthcare facilities; discrimination by healthcare providers and CSO staff, inappropriate questioning of the trans-gender identity by police officers and healthcare providers, and the lack of trans-competent healthcare providers and legal personnel hindered help-seeking following exposure to GBV.

CONCLUSION

The immediate sources of GBV support services included key population-friendly healthcare facilities and CSOs, police, and friends and family. However, a significant number of transwomen did not report incidences of GBV. Transwomen were discriminated against at some key population healthcare facilities and CSOs, and police, which hindered help-seeking following exposure to GBV. This study highlights the need to tackle internalized stigma and discrimination against transwomen at the existing sources of GBV support. There is also a need to train law enforcers and legal personnel on the right to access healthcare among transwomen in Uganda.

Development and validation of a measure of curvy ideals internalization

Several sociocultural female body ideals exist - thin, muscular/athletic, and, more recently, curvier ideals, which research specifically suggests are more prevalent among Black women. Two validated measures assess women's desire for curvier bodies, but neither assess certain facets of curvy ideals (e.g., thick vs. slim-thick) separately. We developed and validated the Curvy Ideals Internalization (CII) Scale, to be used alone or alongside existing measures of appearance ideal internalization. Focus groups among racially/ethnically diverse women informed initial items. A sample of 897 White (37.1%), Black (34.2%), and biracial Black and White (28.7%) U.S. women completed the initial 37-item CII to determine factor structure, narrow the item pool, and examine validity and reliability. A separate sample (N = 366) of U.S. Black, White, and biracial women completed the CII to confirm the factor structure. The final CII has eleven items, with factors assessing thick/curvy ideal internalization and facets of slim-thick ideal internalization: thin waist and large breast size. The CII has adequate internal consistency, test-retest reliability, construct validity, and factorial validity. The CII is appropriate for use among Black, White, and biracial women to assess internalization of curvier body ideals and needs to be validated in more diverse samples.

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.

Individuals who are transgender or nonbinary experience a higher prevalence of certain mental health concerns, including depression, anxiety and disordered eating behaviours. In this Review, Tebbe and Budge discuss these disparities along with factors that protect these individuals from negative outcomes and promote well-being.

Stigma Experienced by Transgender Women of Color in Their Dating and Romantic Relationships: Implications for Gender-based Violence Prevention Programs

Although transgender women of color, specifically Black and Latina experience gender-based violence in a variety of contexts, one of the most consistently reported is from a dating or romantic partner. This qualitative study sought to understand the manifestations and consequences of stigma experienced by transgender women of color in their dating or romantic relationships. Between January and February 2019, we purposively recruited 33 transgender women of color to participate in five focus group discussions and complete a brief survey. We employed both inductive and deductive approaches to coding and thematic analysis. We identified different forms of anti-transgender interpersonal stigma experienced by transgender women of color seeking romantic relationships and by those in romantic relationships. For those dating and seeking relationships, anti-transgender interpersonal stigma took the form of dehumanizing stereotypes and sexual objectification. While these manifestations of anti-transgender interpersonal stigma persisted for some within relationships, concealment behaviors from partners was the predominant type of anti-transgender interpersonal stigma. Each of these forms of anti-transgender interpersonal stigma had significant gender-based violence consequences, specifically encountering physical violence, experiencing psychological trauma, and engaging in survival strategies. In the current climate of COVID-19, which is exacerbating risks of gender-based violence, there is an urgent need to understand and address the nuanced manifestations of stigma in relationships and their consequences on the lives of transgender women of color. Culturally grounded gender-based violence prevention policies and programs with transgender women should address these forms of stigma and build on community strengths. Findings also highlight the importance of future research and gender-based violence prevention programming with cisgender men in/seeking partnerships with transgender women of color.

A Test of Objectification Theory with Sexual Minority Women

With this study, we aimed to advance objectification theory research with sexual minority women by examining the understudied roles of appearance anxiety and interoceptive awareness concomitantly with other key variables, including sexual objectification experiences, internalization of cultural appearance standards, body surveillance, and body shame. We also examined depressive symptoms as a criterion variable in addition to eating disorder symptoms. Survey data from 201 sexual minority women were analyzed. Manifest variable path analysis of the hypothesized model explained 35% and 27% of the variance in eating disorder and depressive symptoms, respectively. Results revealed a distinct pattern of cross-sectional direct and indirect relations for eating disorder and depressive symptoms. Specifically, body shame was a key unique correlate of eating disorder symptoms and linked internalization of cultural appearance standards and body surveillance with eating disorder symptoms. Appearance anxiety was a key unique correlate of depressive symptoms and linked internalization of cultural appearance standards and body surveillance with depressive symptoms. Sexual objectification experiences and interoceptive awareness generally did not yield significant unique direct or indirect relations in the model. These findings suggest distinct and complementary points of intervention to mitigate eating disorder and depressive symptoms for sexual minority women.

Aversive Self-Focus and Alcohol Consumption Behavior in Women with Sexual Identity-Uncertainty: Changes in Salivary Cortisol Stress Response Among Those who Drink-to-Cope

Background

Individuals who report sexual identity-uncertainty are at-risk for heavy alcohol consumption and alcohol use disorder symptomology. The current study examined the impact of states of aversive self-focus on subsequent consumption of ostensibly alcohol-containing beverages among a sample of women in early adulthood with varying levels of sexual identity-uncertainty (N = 75).

Methods

Utilizing a 2 (self-focus: negative vs. neutral) × 2 (attribution for any psychological discomfort: external vs. none given) between-subjects design with 3 within-person assessments of salivary cortisol, both a moderation model and mixed-effects general linear model were tested.

Results

States of aversive self-focus caused increases in overall consumption among women higher in sexual identity-uncertainty. Findings suggested consumption of ostensibly alcohol-containing beverages was more likely among women higher in sexual identity-uncertainty who also reported consuming beverages to cope with distress. Among women who reported higher levels of sexual identity-uncertainty and drinking-to-cope motives, salivary cortisol concentrations dampened more quickly over time, as they supposedly consumed alcohol.

Conclusion

Findings demonstrate that, among women reporting sexual identity-uncertainty who are motivated to consume alcohol to forget about troubles or worries, situations which evoke states of aversive self-focus may contribute to differences in alcohol consumption in early adulthood.

Psychometric properties and validation of the Phenomenological Body Shame Scale - Revised (PBSS-R)

Body shame is a common experience among women yet a challenging phenomenon to operationalize, and measures of body shame often fail to capture its embodied aspects. In this article, we examined the structural and psychometric properties of an existing measure of body shame that was developed by Fredrickson et al. (1998) to assess the motivational and behavioral components of feeling body shame. Across three studies, women participants completed the Phenomenological Body Shame Scale (PBSS) and measures of theoretically related constructs in counterbalanced order via online survey platforms. The results demonstrate evidence of construct validity for an abbreviated, 8-item measure of phenomenological body shame (PBSS-R). In Study 1 (n = 341 community women), we evaluated and confirmed the scale's structural validity as a unidimensional measure. In Study 2 (n = 204 college women), we demonstrated positive associations between the PBSS-R and negative body image attitudes and behaviors, and negative associations with self-compassion, supporting the scale's external validity. In Study 3 (n = 235 community women), the PBSS-R explained variance in intuitive eating and happiness above theoretically related measures of self-objectification and body shame, supporting the scale's incremental validity. We recommend use of this abbreviated measure to assess the more embodied and less evaluative features of body shame in women.

Shame and eating disorders symptoms: A meta-analysis

OBJECTIVE

Numerous empirical studies and theoretical models posit that shame is a common experience among individuals across the eating disorder spectrum. In this study we aim to investigate the association between shame and eating disorders symptoms using a meta-analytical approach.

METHOD

In this meta-analysis, we synthesized findings from 195 studies to examine the proposed association between shame and eating disorders symptoms. We looked at the associations with both general eating disorders symptoms and with specific eating disorders symptoms (i.e., anorexic, bulimic, and binge-eating symptoms). Moderation analyses testing for the effect of type of shame, type of eating symptoms, clinical status, quality of the study, age, and gender were conducted.

RESULTS

Shame was significantly associated with a medium to large effect size with all types of eating disorders symptoms (rs between .40 and .52). Body shame (r = .55) and shame around eating (r = .59) were more strongly related with eating disorders pathology. Type of eating disorders symptoms did not moderate the relationship between shame and disturbed eating.

DISCUSSION

Overall, the magnitude of the effect size of the association between shame and eating disorders symptoms is a medium to large one. Body shame and shame around eating seem to be the types of shame most closely tied with eating disorders symptoms, suggesting that directly targeting them in interventions might be highly beneficial. Findings highlight current gaps in the literature (e.g., mostly correlational studies, low quality studies) with implications for future research.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.

Body image and depressive symptoms among transgender and cisgender adults: Examining a model integrating the tripartite influence model and objectification theory

Studies have shown higher levels of body image concerns and depression among transgender individuals, which may result from the internalized stigma of living in a body that does not conform to the expectations of their affirmed gender. We integrated objectification theory and the tripartite influence model, which both address how internalizing gendered appearance-related expectations are linked to body image and depression, and then determined whether this integrated model varied based on participants' gender identity. Participants included 715 cisgender women, 207 cisgender men, 186 trans men, and 71 trans women from the U.S. A multiple group analysis indicated that thin-ideal and muscular-ideal internalization were serially linked to body shame and depression through body monitoring and appearance comparison, with appearance comparison mediating the link between body monitoring and body shame. While this model was supported for each gender identity group, cisgender men had a relatively weaker relationship from thin-ideal internalization to body monitoring, and trans women had a relatively stronger inverse link from muscular-ideal internalization to body monitoring. Furthermore, the significance of the model pathways often differed based on gender identity. Overall, findings reveal the salience of gender identity in the connections between internalization, body monitoring, appearance comparison, body shame, and depression.

Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature

BACKGROUND

According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM).

MAIN

This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals).

CONCLUSION

LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.