The impact of gender identity change efforts on generalized anxiety, social anxiety, and appearance anxiety among transgender and gender diverse individuals: Investigating general and group-specific psychological processes

Abstract

Background: Gender identity change efforts (GICE) involve practices that pressure individuals to suppress or alter their gender identity to conform to cisnormative norms. While emerging research has begun to document the mental health implications of GICE, there remains a notable gap in understanding their impact on distinct domains of anxiety, which disproportionately affect transgender and gender diverse (TGD) individuals. Aims: This study investigated the prevalence, experiences, and impact of GICE among TGD individuals, with a focus on generalized anxiety, social anxiety, and appearance anxiety. Additionally, the study explores both general and group-specific psychological processes linking GICE and anxiety outcomes. Methods: The study recruited a community sample of 220 TGD individuals. They completed a questionnaire on experiences of GICE, hypervigilance, internalized transnegativity, and anxiety outcomes. Results: Approximately 40% of participants reported having experienced GICE. Of those who had undergone GICE, 69.4% indicated that these efforts began before the age of 18, and 65.9% reported that the experience lasted for more than six months. Compared to those without GICE exposure, individuals with such experiences reported significantly higher levels of social and appearance anxiety. Structural equation modeling showed that hypervigilance and internalized transnegativity mediated the relationship between GICE and anxiety outcomes. Conclusion: The study provides insights into the dual psychological pathways through which the harms of GICE manifest. The findings underscore the urgent need for trauma-informed, gender-affirming mental health services and call for public education and legal regulation to safeguard the rights of TGD individuals.