Researchers continually identify gender dysphoria as a significant mental health concern for many transgender individuals. Physical and mental health providers use the existing medical model to conceptualize and design treatment for gender dysphoria. This means that gender dysphoria is currently viewed and treated as an internal concern isolated to the individual. Researchers have also identified that external factors, such as discrimination and societal prejudice, have a significantly negative impact on the health of transgender individuals. Given that current conceptualizations of gender dysphoria focus on internal contributors to distress, external factors that also potentially contribute to gender dysphoria have not yet been explored. To address this gap in the literature, I conducted a study to identify and assess the severity of various external factors that may contribute to self-reported levels of gender dysphoria in transgender individuals. I recruited 195 participants who identify as transgender and who report experiencing gender dysphoria. Participants completed a survey that included the Transgender Congruence Scale, the Gender Preoccupation and Stability Scale, the Multidimensional Scale of Perceived Social Support, Gender Minority Stress and Resilience subscales, and the Gender Dysphoria from External Contributors Measure, a series of Likert-type scales developed for the present study that measure frequency of gender dysphoria experienced in a variety of external contexts. I conducted hierarchical multiple regression analyses to evaluate predictors for gender dysphoria from external contributors and gender dysphoria from internal contributors. Gender dysphoria from internal contributors was significantly associated with gender dysphoria from external contributors (r = 0.51). Several predictors uniquely predicted external contributors (i.e. gender-related rejection and gender-related discrimination) while others uniquely predicted internal contributors (i.e. internalized transphobia). Findings indicate that focusing solely on internal contributors generates an incomplete conceptualization of gender dysphoria. The results from this study allow for a more comprehensive understanding of gender dysphoria and the ways in which it impacts many transgender individuals. These results will be helpful in developing more accurate measures of gender dysphoria, which will lead to more effective, inclusive, and affirmative treatments for gender dysphoria and for transgender individuals in general.

Individuals with LGBTQ+ identities face discrimination and bigotry, components of their minority status stress, often on a daily basis (Meyer, 2003). Elevated levels of minority stress have been negatively associated with relationship satisfaction (e.g. Rostosky, 2007), such that as minority stress increases, relationship satisfaction often decreases as well. This is an examination of the relationship between general stress, identity-related stress, minority stress, and relationship satisfaction for sexual/gender minority and heterosexual, cisgender individuals who were currently in couple relationships lasting 6 months or longer. All participants completed the Romantic Perceptions Survey, Gender Relations Scale, and Daily Hassles Scale – Short Form. The LGBTQ+ participants also completed the LGBT Minority Stress Measure. I conducted t-test comparisons to examine group differences between heterosexual, cisgender participants and LGBTQ+ participants on relationship satisfaction, identity-related stress, and general stress. The LGBTQ+ and participants exhibited significantly higher levels of relationship satisfaction, general stress, and self-rated identity-related stress than did heterosexual, cisgender participants. I also conducted two hierarchical linear regressions to determine how general stress and identity related stress impacted relationship satisfaction for heterosexual, cisgender participants, and how general stress, identity related stress, and minority stress impacted relationship satisfaction for LGBTQ+ couples. Results of the hierarchical linear regressions were interpreted and found that general and self-rated identity-related stressors in combination predicted relationship satisfaction for LGBTQ+ participants, and general stress alone best predicted relationship satisfaction for heterosexual, cisgender participants. Specific minority status stress did not further contribute to the explanation of relationship satisfaction for LGBTQ+ participants. Results are discussed in terms of implications for research and practice.

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Rural populations are traditionally understudied, especially as it is concerned with the experiences of sexual minority women. Previous research has found that sexual minorities experience worse health outcomes in comparison to heterosexual individuals, which could be due to minority stress (the unique stressors they face as sexual minorities, such as discrimination and concealment of sexual orientation) (Meyer, 2003). More recent research has found that the relationship between minority stress and health outcomes has been mediated by social variables, like social isolation (Hatzenbuehler et al., 2009). Thus, the current study examined the indirect effects of proximal minority stress of concealment on self-rated health and quality of life through various social factors (community connectedness, social support, indirect support seeking, and belongingness). Participants included 134 sexual minority women in Northeast Tennessee. Participants completed the following measures: the Short Form LIHS (Szynmanski & Chung, 2001); Indirect Social Seeking Scale (Barbee & Cunningham, 1995); the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988); the Belongingness Scale (Malone et al., 2012); the Connectedness to the LGBT Community Scale (Frost & Meyer, 2012); WHOQOL-BREF (World Health Organization, 1998); SF36v2 (Health Survey, 1996). In order to test that belongingness, social support, indirect support seeking, and community connectedness mediated the relationship between concealment to quality of life and self-rated health, a mediational analysis was conducted using PROCESS (Hayes, 2014) macro. Analysis showed that concealment was indirectly linked through belongingness with quality of life and self-related health. Concealment significantly predicted belongingness (b = -.327, p = .021), which in turn significantly predicted self-rated health life (b = .214, p = .004) and quality of life (b = .251, p < .001). A mediational analysis was conducted, and it was found that concealment had an indirect effect on self-rated health through belongingness (effect = -.070, 95% CI = -.1865, -.0105) and indirect effect on quality of life through belongingness (effect = -.066, 95% CI = -.161, -.001). All other mediational analyses were nonsignificant. Our results suggest that cognitive aspects of social life, like perceived belongingness, may be an important mechanism through which minority stress affects health.

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The minority stress theory proposes that higher rates of mental illness among individuals who identify as lesbian, gay, or bisexual result from various factors that one may experience as a function of their minority status (Meyer, 1995, 2003). Such factors include internalized homophobia, concealment of one’s sexual identity, and the experiences of discrimination and rejection, whether real or perceived. This study investigated the relationship between minority stress and working memory. Based on the well documented research finding of the higher prevalence of mental illness among individuals who identify as lesbian, gay, or bisexual, relative to their heterosexual counterparts (S. D. Cochran, Sullivan, & Mays, 2003; Hatzenbuehler, 2009; Mays & Cochran, 2001), it was hypothesized that higher levels of minority stress would predict higher levels of psychological distress. In addition, models of chronic stress have predicted that individuals who are under constant stress conditions are more likely to have working memory deficits (Egeland et al., 2005; Schmader & Johns, 2003). Thus, it was hypothesized that the relationship between minority stress and working memory would be mediated by psychological distress. Identity valence is the evaluation of one’s identity and could be either positive or negative (Ashmore, Deaux, & McLaughlin-Volpe, 2004; Meyer, 2003). It was hypothesized that identity valence would further mediate the relationship between minority stress and working memory. Participants included 309 adults who identify as lesbian, gay, or bisexual (LGB), recruited via community-based and snowball sampling techniques (Meyer & Colten, 1999; Meyer & Wilson, 2009). Structural equation modeling (SEM) was utilized to examine direct and indirect effects of the relationship between minority stress and working memory. Results indicated that higher levels of working memory predict higher levels of psychological distress. Further, the relationship between minority stress and working memory was mediated through psychological distress and rumination. Finally, identity valence did not have the protective factor that was hypothesized and demonstrated in previous literature (Kertzner, Meyer, Frost, & Stirratt, 2009; Meyer, 2003). Rather, higher levels of identity valence predicted higher levels of psychological distress. Implications, strengths, limitations, and directions for future research are discussed. / School Psychology