Gender dysphoria and minority stress: Support for inclusion of gender dysphoria as a proximal stressor

The minority stress model describes the unique stressors that impact sexual and gender minorities above and beyond general stressors and includes both external (distal) and internal (proximal) sources of stress. Proximal stressors are the thoughts and feelings that are elicited and maintained because of direct and indirect experiences with prejudice events and are typically conceptualized to include anticipated stigma, internalized transphobia, and gender identity concealment. Recently, gender dysphoria has been proposed as a proximal stressor due to its interactive nature with both external triggers and mental health symptoms. However, gender dysphoria has not been tested empirically in prior published models of gender minority stress. Trans and nonbinary participants (N = 297) over the age of 18 were recruited via postings on social networking websites. Participants identified as trans feminine (n = 128), trans masculine (n = 110), nonbinary (n = 49), and agender (n = 10), and ranged in age from 18 to 67 (M = 28, SD = 9.42). Through a confirmatory factor analysis, it was shown that internalized transphobia, anticipated stress, gender identity concealment, and gender dysphoria reflect the latent factor proximal stress. Findings from this study suggest that gender dysphoria should be understood as a proximal stressor. As such, clinical interventions that target how individuals internalize experiences in a cisnormative society could have a positive impact on the severity of gender dysphoria. Additionally, modeling gender dysphoria as a proximal stressor can help future research disaggregate gender dysphoria from negative mental health symptoms such as anxiety or rumination.