Nonsuicidal Self-Injury Among Gender Minority Populations

This dissertation research constitutes a mixed methods investigation of the phenomenon of nonsuicidal self-injury (NSSI) among transgender and gender nonconforming (TGNC) people. An integrative review of the current literature about NSSI among sexual and gender minority populations established that NSSI is reported at higher rates by sexual and gender minorities than by cisgender (nontransgender) and heterosexual populations. Additionally, TGNC people appeared to report higher rates of NSSI than cisgender sexual minorities. Among TGNC people, transmasculine spectrum people (i.e., gender identity is male, man, transgender man, transmasculine, genderqueer, nonbinary, etc., with female sex assigned at birth) reported higher rates of NSSI compared to transfeminine spectrum people (i.e., gender identity is female, woman, transgender woman, transfeminine, genderqueer, nonbinary, etc., with male sex assigned at birth). Guided by Meyer’s (2003) minority stress model and Nock’s (2009) model of NSSI, qualitative interviews were conducted with eighteen transmasculine individuals to understand what contributes to the higher rates of NSSI in this population. The qualitative data supported aspects of Nock’s model as well as minority stress processes, and additionally revealed that NSSI may be related to transgender identity development processes. Aspects of Nock’s model that were supported included risk factors for NSSI (adverse childhood experiences), intrapersonal and interpersonal vulnerability factors, and identification with the behavior. Minority stress processes related to stigma associated with transgender identity included the impact of nonconformity in appearance and behavior, nonconformity in identity with nonbinary identified participants reporting additional stress, concealment of identity, and expectations of rejection. Transgender identity development stages of pre-coming out (confusion prior to understanding one’s gender identity), coming out, and exploration (finding a community of similar peers) were also related to NSSI. This latter finding highlighted that, in addition to being a response to stigma and minority stress, NSSI may occur in the context of normal transgender identity development. Finally, a quantitative investigation was conducted to examine correlates of past-year NSSI among a diverse community-based sample of TGNC people. In the total sample (N = 332), 53.3% (n = 177) of participants reported having engaged in NSSI in their lifetime. Lifetime history of NSSI was more common among transmasculine spectrum compared to transfeminine spectrum participants (60.5% vs. 39.5%, p < 0.001). Past 12-month NSSI was reported by 22.3% (n = 74) of the sample and was not significantly different between transmasculine and transfeminine spectrum participants. Younger age and higher levels of felt stigma were associated with higher rates of NSSI, while transgender identity acceptance and congruence were protective factors. Together, the findings of this mixed method investigation provided new insights into the onset and maintenance of NSSI among TGNC people, informing the development of interventions to address the high rates of NSSI among gender minority populations. Implications for theory, clinical practice, provider education and training, health policy, and future research are discussed.