Differential Experiences of Sexual,Physical,and Emotional Intimate Partner Violence Among Transgender and Gender Diverse Adults

Abstract

Various forms of intimate partner violence (IPV) are unfortunately common amongst adults in the United States, and these rates are devastatingly higher for transgender and gender diverse (TGD) individuals than for the general population. However, the TGD population is not monolithic, and is diverse regarding gender, sexual orientation, age, race/ethnicity, urbanicity, and other sociodemographic categories. This study uses data from the 2018 Michigan Trans Health Survey to explore these within group differences regarding sexual, physical, and emotional forms of IPV using chi-square tests of independence and logistic regressions. Chi square tests of independence found homelessness had significant associations across all outcome variables: “ever experienced physical violence from a partner,” “ever experienced forced sex from a partner,” “ever been threatened to be outed by a partner,” and “ever had gender belittled by a partner.” Gender identity and sexual orientation had significant associations with “ever experienced forced sex from a partner,” “ever been threatened to be outed by a partner,” and “ever had gender belittled by a partner.” Urbanicity showed a significant association with “ever being threatened to be outed by a partner.” In the logistic regressions, age indicated significantly higher likelihood of IPV physical IPV with each year of age; experiences of homelessness were significantly related to likelihood for all outcomes variables. Gender and sexual orientation were also significant across the models, with differing levels of likeliness depending on identities. Findings demonstrate a need for TGD inclusive programming, and specifically programs that target TGD persons who are older, report additional genders (meaning, multiple identities and/or identities besides transfeminine, transmasculine, or nonbinary), queer sexual orientations, and who are/have experienced homelessness. Programs are needed both in the realms of intimate partner violence prevention work and social services that support survivors of violence, such as mental health clinics, rape crisis centers, and shelters.

Keywords

Sexual assault dating violence transgender gender diverse nonbinary gender identity

Introduction

Experiences of intimate partner violence (IPV) are tragically frequent, affecting almost 40% of the general population of adults in the United States (U.S.) (Bott et al., 2019), and are even significantly higher for transgender and gender diverse (TGD) adults, affecting over half of this population in their lifetime (Peitzmeier et al., 2020; James et al., 2016). Historically the TGD population has often been represented as homogenous in research, though that is not the case. For example, studies have either drawn broad conclusions about IPV among TGD populations that erase within-group diversity (e.g., different experiences among transmasculine, transfeminine, and nonbinary persons) (see: Wirtz, Poteat, Malik & Glass, 2020) and few studies consider intersecting forms of marginalization that may impact the experience of IPV among this group. This study examined how race/ethnicity, sexual orientation, gender, age, urbanicity, and experiences of homelessness influence a TGD individual’s likelihood of having experienced emotional, physical, and/or sexual IPV within the past year.

Literature Review

Transgender and Gender Diverse Identities

The terms transgender and gender diverse (TGD) are often used to refer to individuals whose gender identity differs from the societal expectations associated with the sex assigned to them at birth. The term transgender is commonly used to describe a diverse group of people, including individuals who identify as something other than that which was societally assigned at birth, such as people who identify as transfeminine, woman, transmasculine, man, as well as individuals who identify with multiple genders (i.e., bigender). Also included are individuals whose gender does not fit within the bounds of the gender binary (“male/man” or “female/woman”), and who may self-describe their gender as genderqueer, gender fluid, nonbinary, agender, or something else. There are a myriad of ways in which an individual internally relates to and outwardly expresses their gender. Some may want gender-affirming medical interventions, such as feminizing and/or masculinizing hormone therapies or surgeries, while others may not want any procedures. Of critical importance is the multiple access barriers often faced by those who desire gender-affirming medical interventions, such as finance and insurance issues and a lack of service availability, among others (Puckett, Clearly, Rossman, Newcomb, & Mustanski, 2018). Importantly, the terms people use to describe themselves evolve over time, and the words that join people together for social or political purposes may not accurately reflect the heterogeneity of individual people within the group or community the group represents. This is a limitation of language (Shelton J. and Dodd, 2020). We recognize that researchers and communities do not always agree on who “counts” as transgender. Thus, in an effort to be as inclusive as possible, this article uses the term TGD to refer to this community and the data is drawn from a community-based study that adopted broad and community-informed criteria for inclusion. Because of the evolution of identity-based language, prevalence rates of TGD identities vary across studies. An estimated 0.6% of adults in the U.S. identify with a gender somewhere on the TGD spectrum (Herman et al., 2017). Individuals under the age of 24 are increasingly likely to identify as TGD, with 0.7%–3.2% of young people identifying as TGD (Eisenberg et al., 2017; Herman et al., 2017; Wilson & Kastanis, 2015).

IPV Among Cisgender Adults

Intimate partner violence (IPV)—defined as “any physical, sexual, or psychological/emotional harm by a current or former partner or spouse”—is a pervasive problem and significant public health issue in the United States and globally (Centers for Disease Control and Prevention, 2020). Much research conducted about IPV has centered the experiences of cisgender women. A recently published systematic review of national estimates of IPV among married/cohabitating cisgender women aged 15–49 in the United States (U.S.) found a prevalence rate of 37.3% for ever experiencing physical and/or sexual violence (95% confidence interval [CI]: 36.3–38.3). Specifically, 16.4% [95% CI: 15.6–17.1] of cisgender women had ever experienced sexual violence and 32.4% had ever experienced physical violence (95% CI: 31.5–33.4) within a relationship with a partner (Bott et al., 2019).

IPV can have manifold negative physical, sexual, and emotional/mental health consequences for those experiencing it, some of which can last a lifetime (Bosch et al., 2017; Li et al., 2014; Spencer et al., 2019). Drawing on nationally representative population-based data, Bosch et al. (2017) found that compared to cisgender women without a history of IPV, those with a history of IPV were more likely to report health-compromising behaviors such as smoking and binge drinking, and to report more poor mental health days. These mental health associations have been well-corroborated, as a meta-analysis drawing on data from 207 studies found that anxiety, PTSD, and depression were strongly correlated with physical IPV victimization (Spencer et al., 2019). Another meta-analysis drawing on data from 28 studies found that physical IPV and any type of IPV were significantly associated with HIV among cisgender women (Li et al., 2014).

The power imbalance that fuels perpetrators of IPV occurs within a context of intersecting oppressions. Gender inequality is associated with worsened rates of IPV (Willie & Kershaw, 2019). For example, Willie and Kershaw (2019) identified a positive correlation between U.S. state-level gender inequality, measured using an index developed by the United Nations, reflecting gender-based disadvantage in reproductive health, empowerment, and labor market participation, and the prevalence of any form of IPV among both cisgender men and women, and with psychological IPV among cisgender women. A multitude of studies have also documented heightened risks of IPV for those living at the intersection of multiple marginalized identities, particularly among racialized women, women living in poverty, sexual minority women, and women living rurally (Chen et al., 2020; Decker et al., 2019; Edwards, 2015; Gillum, 2019). For example, Gillum (2019) described the intersection of experiencing poverty and IPV among Black women through a context of colonialism and anti-Black racism. Importantly, racism and sexism also intersect to limit Black women’s access to recourse after violence; specifically, researchers have documented the ways in which intersecting racism and sexism function to discourage police reporting of violence against women (Decker et al., 2019). Chen et al. (2020) identified differences in rates of sexual violence, stalking, and IPV among a nationally representative sample of U.S. participants. Specifically, compared with heterosexual women, bisexual women experienced more IPV and negative IPV-related impact (e.g., symptoms of PTSD) (Chen et al., 2020).

IPV Among TGD Adults

Recent literature has documented disproportionate rates of IPV among TGD adults, with prevalence estimates ranging from 31%-54% (Brown & Herman, 2015; James et al., 2016; Langenderfer-Magruder et al., 2016; Peitzmeier et al., 2020). In their systematic review and meta-analysis of IPV in TGD populations, Peitzmeier et al., 2020 found high rates of IPV across studies, including a median lifetime prevalence of 37.5% for physical IPV and a median lifetime prevalence of 25.0% for sexual IPV. Past-year prevalence rates of physical and sexual IPV were 16.7% and 10.8%, respectively. In one study, transgender women were found to be six times more likely than cisgender women to experience IPV (Valentine et al., 2017). Among the 27,715 respondents to the U.S. Transgender Survey (USTS), 54% of TGD adults reported experiencing IPV at some point in their lives (James et al., 2016).

IPV often manifests in unique ways for TGD individuals, such as threats to disclose one’s gender identity and control of access to trans-affirming healthcare and community connections (Garthe et al., 2018; King et al., 2019; Peitzmeier et al., 2020). While these aspects (e.g., control of medication/access to health care) and social isolation are abuse tacts among cisgender adults as well, the negative consequences are manifold and dire for TGD persons, who experience higher rates of suicide in the absence of access to gender-affirming medical care and social support (Bauer et al., 2015). TGD adults may also experience trans-specific forms of IPV including intentional mis-pronouning and/or dead-naming, gaslighting or undermining of their gender identity, or assertions that a TGD person is not a “real” man or woman (Cook-Daniels, 2015; James et al., 2016). While the violation of boundaries is a common aspect of IPV, boundary violations for TGD individuals can include a refusal to respect physical boundaries regarding touching body parts that are off limits and/or a refusal to use the terminology a TGD individual uses to refer to their body parts (Cook-Daniels, 2015). Trans-specific forms of IPV such as those listed above can have a profound impact on an individual’s mental health. For instance, being addressed by the correct name and pronoun is a critical aspect of affirming one’s gender, and this type of affirmation is associated with improved mental health among TGD people (Glynn et al., 2016; Sevelius et al., 2020).

The 2015 USTS queried respondents about a range of IPV experiences, grouped into two categories—coercive control (including emotional harm, financial harm, and intimidation) and physical harm, which also included threats of physical violence. Almost half (44%) of respondents experienced some form of coercive control and nearly half (42%) experienced IPV involving physical violence or the threat of physical violence. One in four reported emotional IPV in the form of a partner telling them they were not “real” men or women. Limiting contact with peers and family was also prevalent: 23% of respondents were kept from speaking with or seeing family and friends, and 15% were unable to leave the house. TGD adults were nearly three times as likely (16%) than the general population (6%) to report being stalked (James et al., 2016).

TGD individuals who are multiply marginalized due to their race/ethnicity, housing status, or disability, as well as sex workers and individuals who are undocumented experience heightened rates of IPV. In the USTS, rates of IPV were highest among American Indian (73%), multiracial (62%), and Middle Eastern (62%) TGD individuals (James et al., 2016). Approximately two-thirds of undocumented individuals (68%) and individuals with disabilities (61%) reported some form of IPV (James et al., 2016). TGD adults with a history of homelessness have increased odds of experiencing all forms of IPV, including 2.5 times the likelihood of experiencing physical IPV, 2.4 times the likelihood of experiencing psychological IPV, 2.3 times the likelihood of experiencing forced sex with a partner, 2.2 times the likelihood of experiencing stalking, and 2.1 times the likelihood of experiencing trans-related IPV (King et al., 2019). Similar odds exist among sex workers. TGD sex workers had at least two times the likelihood of forced sex, emotional IPV, and stalking, 1.9 times the likelihood of physical IPV, and 1.7 times the likelihood of trans-specific IPV (King et al., 2019).

Research Question

Given the limited research on TGD persons and their overall experiences of sexual, physical, and emotional IPV, we pose the following question: How do TGD adults experiences of sexual, physical, and emotional IPV vary across gender identity, race, age, sexual orientation, urbanicity, and homelessness? We hypothesize that identities and experiences that have been tied to marginalization (such as Black, indigenous, and other people of color; those in rural areas, those with experiences of homelessness, those who are not heterosexual, older adults, etc.) will have reported higher rates of different types of IPV than their counterparts with more privileged identities. It is our hope that having a more nuanced understanding of how individuals with multiply marginalized identities experience IPV will lead towards more inclusive and affirming prevention programs and spaces for survivors of IPV.

Methodology

Methods and Procedures

In 2018, the Michigan Trans Health Survey was conducted in partnership with a TGD-focused, community-led organization Transcend the Binary and the first author. From January-March 2018, a collaboration of TGD individuals who participated in a Transcend the Binary led focus group and several TGD-focused health researchers who made up the Transgender Research group at the University of Michigan created cross-cutting survey items related to identities, health, well-being and personal experiences of harassment, trauma or discrimination. Members of this team and individuals at Transcend the Binary reviewed the final questionnaire draft and provided recommendations for terminology, questioned wording, and item arrangement. Survey piloting was conducted with 10 TGD individuals from outside of the state in which the survey was being conducted (as to not exclude those who reside in the state from participating in the survey) regarding length of the survey, cultural responsiveness, and flow. One additional cognitive interview was run with a blind (cisgender) individual in order to ensure that the survey was screen reader compatible for further accessibility. On average, the survey took between 25 and 30 minutes; however, some participants completed the survey in less than 15 minutes while others took closer to 60 minutes. The survey was determined to be exempt via the University of Michigan Institutional Review Board. Participants were given $10 Mastercard gift cards upon completion of the survey.

The inclusion criteria for survey participation were as follows: must be 18 years of age or older, live in the state of Michigan, and identify as “transgender, trans, non-binary, genderqueer, agender, genderfluid, two-spirit, transsexual, or another non-cisgender identity.” Additionally, participants had to consent to the survey before responding to questions. Recruitment occurred both online and in-person throughout the state of Michigan from May through September in 2018. Online recruitment included individual and organizational posts on Facebook, Twitter, and websites; and via email and listservs to disseminate the survey online. Some recruitment on social media included paid advertising. In-person recruitment consisted of team members handing out palm card and business size recruitment cards at various transgender events, Pride events, community organizations, and health-provider offices throughout the state. Primarily, convenience sampling was utilized to recruit participants for the study. Many participants shared the survey upon completion with their networks, adding an additional snowball sampling method. While no paper copies were returned, many community organizations offered paper copies at their location.

Measures

The predictor variables were collected on the Michigan Trans Health Survey as sociodemographic information which had a large range of response selections that was cleaned and coded by the research team and then re-coded for this analysis. Gender identity was condensed from eight values into four by combining female/woman and trans feminine into one value for transfeminine genders, male/man and trans masculine into one value for transmasculine genders, nonbinary/gender queer/gender fluid as its own value, and trans/transgender, multiple gender and additional genders into one value capturing identities that vary from more mainstream language use and/or had fewer responses such as bigender, agender, demigender, and two-spirit.

Sexual orientation was condensed from 10 values into six values in the following way: by combining gay, lesbian, and homosexual into one value that captures single gender attraction or monosexual identities; by combining bisexual, omnisexual, pansexual, multiple orientations into one value that captures multiple gender attraction sexualities or polysexual; by making straight/heterosexual its own monosexual value; and by making asexual/demisexual its own value.

Racial identity was re-coded from nine values to five values to include Black/African American, Latinx/Chicanx/Hispanic, White, Biracial/Multiracial, and an additional racial identity value that combined Asian, Asian American, Pacific Islander, Native, Indigenous, American Indian, Middle Eastern, Romani and additional races, as responses within these racial identities were too small to keep separate due to confidentiality concerns and statistical limitations.

The geographic region variable was re-coded from five values to a bivariate value by combining urban and suburban into one value to capture more densely populated areas and by combining small city, rural, and frontier into one value to capture less densely populated areas. Age remained as a continuous variable and there was also a homelessness variable that was re-coded from four response options to a dichotomous yes/no variable for having ever experienced homelessness.

The outcome variable for ever experienced physical violence from a partner was created by combining two variables: “My partner pushed, shoved, or slapped me and my partner punched or kicked me or beat me up.” The response labels for these two original variables were “yes, in the past 12 months,” “yes, before the past 12 months,” “yes, both in the past 12 months and before that,” and “no.” All the “yes” responses were combined to create a dichotomous yes or no variable that was then combined to create one “ever experiencing physical violence from a partner” variable.

Similarly, two variables were combined to create a new forced sex variable. The original two questions, “My partner used force (like hitting, holding down, or using a weapon) to make me have sex or a certain kind of sexual activity” and “My partner insisted on sex or a certain kind of sexual activity when I did not want to (but did not use physical force)” were made into separate dichotomous variables with the same labels as noted above before being combined into the “ever experienced” forced sex variable.

The two other outcome variables, “My partner threatened to ‘out’ me (tell other people I am transgender/non-binary)” and “My partner belittled me by saying I am not a ‘real’ man or ‘real’ woman or that I am not trans ‘enough’” were made into dichotomous “yes” or “no” variables for the “ever experiencing being threatened to be outed by a partner” variable and the “ever had gender belittled by a partner” variable. While these variables both constitute emotional IPV, they were kept separate rather than combined to capture the trans-specific manifestations of emotional IPV. These items were originally proposed by an IPV scholar on the survey team, and were then workshopped by community partners and focus group members to be an accurate representation of how they wanted to assess IPV in their community. It should be noted that this section of questions was proceeded by a note that this section talked about issues perpetuated by intimate partners, and would look at multiple types of violence, both in an effort to provide a content note for participants, as well as to avoid people answering in the affirmative about actions that might take place in a consensually navigated exchange (such as face slapping in a kink context).

Data Analysis

The initial dataset was cleaned for exclusionary/ineligibility criteria and duplicate or illogical responses. Sociodemographic domains (gender, sexual orientation, race/ethnicity, and religious/spiritual identities) had qualitative response options. These responses were coded into categorical variables for use in quantitative analysis. More information on this initial study can be found in Kattari et al., 2020. Further, for the purposes of this study, only those who responded fully to the IPV section of the survey were included in this analysis. There was less than five percent missing data across independent variables and therefore no missing data analysis was conducted. Chi-square tests of independence were conducted to assess the relationship between the predicator variables (gender identity, sexual orientation, race, geographic region, homelessness, and age) and the outcome variables (“ever experienced physical violence from a partner,” “ever experienced forced sex from a partner,” “ever been threatened to be outed by a partner,” and “ever had gender belittled by a partner”). Multivariate regressions were further conducted on utilizing all predictor variables to further explore directionality and strength of associations.

Descriptive Characteristics of Sample

Descriptive characteristics of sample (see Table 1) are shown for all respondents of the 2018 Michigan Trans Health Survey (n=557). The mean age of the sample was 28.61 (SD: 10.2741). 28.4% of the sample identified as a man/transman/transmasculine, 19.4% as a woman/transwoman/transfeminine, slightly over a quarter as nonbinary, and 22.3% as an additional gender. A large majority (58.9%) of participants identify as polysexual, 21% as not-straight monosexual, 11.3% as straight monosexual, and 4.3% as asexual or demisexual. A large majority of the sample identified as White (76.5%) and lived in an urban/suburban area (69.7%). Over a third (39.0%) have ever experienced homelessness (Table 2).

Table 1.

Demographic Breakdown (n = 557).

Variable	n	%
Predictors
Gender Identity
Transfeminine	108	19.4
Transmasculine	158	28.4
Nonbinary	149	26.8
Additional genders	124	22.3
Missing	18	3.2
Sexual Orientation
Monosexual (not straight)	117	21.0
Monosexual (straight/heterosexual)	63	11.3
Polysexual	328	58.9
Asexual/Demisexual	24	4.3
Missing	25	4.5
Race
Black/African American	37	6.6
Latinx/Chicanx/Hispanic	24	4.3
White	426	76.5
Multiracial/Biracial	28	5.0
Additional races	17	3.1
Residence
Urban/Suburban	388	69.7
Small city/Rural/Frontier	169	30.3
Age (mean/Standard deviation)	28.60	10.27
Ever Experienced Homelessness
Yes	217	39.0
No	339	60.9
Outcomes
Ever Experienced Physical Violence from a Partner
Yes	187	33.6
No	370	66.4
Ever Experienced Forced Sex from a Partner
Yes	218	31.9
No	339	60.9
Ever been Threatened to be Outed by a Partner
Yes	111	19.9
No	446	80.1
Ever had gender Belittled by a Partner
Yes	151	27.1
No	406	72.9

Table 2.

Chi Square Tests of Independence of Demographics by IPV Experiences.

Variable	Ever Experienced Physical Violence from a Partner (n = 557)			Ever Experiences Forced Sex from a Partner (n = 557)			Ever been Threatened to be Outed by a Partner (n = 557)			Ever had Gender Belittled by a Partner (n =557)
Predictor	N	%	P	N	%	P	N	%	P	N	%	P
Age (M/SD)	30.03	9.67	*	27.98	8.48		29.07	10.67		29.06	9.41
Gender Identity						***			***			***
Transfeminine	33	30.6		33	30.6		20	18.5		29	26.9
Transmasculine	44	27.8		39	24.7		10	6.3		24	15.2
Nonbinary	49	39.5		60	48.4		42	33.9		51	41.1
Additional genders	49	39.5		72	48.3		27	18.1		36	24.2
Sexual Orientation			**			***			***			***
Monosexual (not straight)	55	47.0		58	49.6		47	40.2		52	44.4
Monosexual (straight)	19	30.2		9	14.3		4	6.3		7	11.1
Polysexual	94	28.7		126	38.4		43	13.1		3	12.5
Asexual/Demisexual	6	25.0		11	45.8		3	12.5		75	22.9
Race						*
Black/African American	8	21.6		9	24.3		5	13.5		8	21.6
Latinx/Chicanx/Hispanic	8	33.3		9	37.5		6	25.0		7	29.2
White	140	32.9		156	36.6		76	17.8		107	25.1
Multiracial/Biracial	9	32.1		17	60.7		6	21.4		8	28.6
Additional races	6	35.3		8	47.1		2	11.8		6	35.3
Residence									**
Urban/Suburban	137	35.3		157	40.5		88	22.7		112	28.9
Rural/Small city/Frontier	50	29.6		61	36.1		23	13.6		39	23.1
Ever Experienced Homelessness			***			***			***			***
Yes	122	56.2		119	54.8		74	34.1		95	43.8
No	95	43.8		98	29.0		37	10.9		56	16.5

Note. *p < .05, **p < .01, ***p < .001

Among the outcome variables, 33.6% indicated that they have ever experienced physical violence from a partner, a third (31.9%) reported ever experiencing forced sex from a partner, 19.9% reported ever been threatened to be outed by a partner, and 27.1% indicated that they ever had their gender belittled by a partner.

Results

Multivariate Results of Physical, Sexual, and Emotional IPV Across Characteristics

The chi-square tests of independence found that homelessness and sexual orientation have significant associations across all outcome variables; ever experienced physical violence from a partner, ever experienced forced sex from a partner, ever been threatened to be outed by a partner, and ever had gender belittled by a partner. Age has a significant association with “ever experienced physical violence” but not with the other outcome variables. The predictor variables of gender identity had significant associations with three outcome variables: “ever experienced forced sex from a partner,” “ever been threatened to be outed by a partner,” and “ever had gender belittled by a partner.” Urbanicity showed a significant association with “ever been threatened to be outed by a partner.” Race has a significant association with the outcome variables of forced sex.

Logistic Regression Results of Differences in Physical, Sexual, and Emotional IPV by Characteristics

Age

The multivariate regression (Table 3) shows four models holding all predictor variables constant. Age was statistically and linearly significant in the “ever experienced physical violence from a partner” model (OR = 1.02, p < .05), and no other models.

Table 3.

Logistic Regressions of IPV Experiences.

Variables	Ever Experienced Physical Violence from a Partner		Ever Experienced Forced Sex from a Partner		Ever been Threatened to be Outed by a Partner		Ever had Gender Belittled by a Partner
Variables	OR	95% Confidence Interval	OR	95% Confidence Interval	OR	95% Confidence Interval	OR	95% Confidence Interval
Age	1.02*	[1.00, 1.05]	0.99	[0.97, 1.02]	1.01	[0.98, 1.03]	1.00	[0.976, 1.02]
Gender Identity (Transmasculine)
Transfeminine	0.85	[0.45, 1.58]	1.10	[0.60, 2.02]	2.09	[0.86, 5.04]	1.45	[0.74, 2.85]
Nonbinary	1.24	[0.71, 2.17]	2.23**	[1.33, 3.74]	3.08*	[1.36, 6.95]	1.42	[0.77, 2.61]
Additional genders	1.20	[0.67, 2.16]	2.08**	[1.19, 3.64]	4.97***	[2.22, 11.13]	2.61**	[1.40, 4.86]
Sexual Orientation (Polysexual)
Monosexual (not straight)	1.57	[0.96, 2.57]	1.35	[0.84, 2.16]	3.62***	[2.11, 6.22]	2.15**	[1.32, 3.51]
Monosexual (straight)	1.08	[0.54, 2.15]	0.34**	[0.15, 0.77]	0.96	[0.34, 2.75]	0.62	[0.27, 1.44]
Asexual/Demisexual	0.82	[0.31, 2.17]	1.19	[0.51, 2.79]	0.85	[0.24, 3.08]	0.59	[0.19, 1.83]
Race/Ethnicity (white)
Black/African American	0.50	[0.20, 1.22]	0.54	[0.23, 1.26]	0.61	[0.20, 1.80]	0.58	[0.23, 1.50]
Latinx	0.63	[0.24, 1.68]	0.63	[0.24,1.62]	1.08	[0.35, 3.33]	0.76	[0.27, 2.14]
Multiracial/Biracial	1.01	[0.42, 2.46]	2.16	[0.96, 4.86]	1.33	[0.49, 3.59]	1.11	[0.46, 2.65]
Additional races	1.69	[0.51, 1.26]	1.35	[0.50, 3.66]	0.60	[0.12, 3.02]	1.68	[0.57, 4.94]
Residence (Urban)
Rural/Small town/Frontier	0.80	[0.51, 1.26]	0.93	[0.61, 1.42]	0.78	[0.44, 1.37]	1.01	[0.63, 1.62]
Ever experience Homelessness (No)
Yes	5.52***	[3.65, 8.34]	2.92***	[1.96, 4.33]	3.15***	[1.90, 5.22]	3.28***	[2.13, 5.05]

Note. *p < .05, **p < .01, ***p < .001

Homelessness

Homelessness was also statistically significant across all four models: ever experienced physical violence from a partner (OR = 5.52, p < .001), ever experienced forced sex from a partner (OR = 2.92, p < .001), ever been threatened to be outed by a partner (OR = 3.15, p < .001), and ever been belittled by a partner (OR = 3.28, p < .001).

Gender identity

Gender identity was significant in three of the four models. Those whose gender identity was captured in the label of additional genders had higher odds ratio of ever experienced forced sex from a partner (OR = 2.08, p < .01), had almost five times the odds of ever been threatened to be outed by a partner (OR = 4.97, p < .01), and more than twice the odds of ever had their gender belittled by a partner (OR = 2.61, p < .01) compared to transmasculine individuals. Nonbinary individuals had higher odds of ever having experienced forced sex (OR = 2.23, p < .01) of ever been threatened to be outed by a partner (OR = 3.08, p < .001) compared to transmasculine individuals. No other variables were significant in the models.

Sexual orientation

Sexual orientation was significant in three of the four models. Straight identified individuals had lower odds of ever experiencing forced sex from a partner (OR = 0.34, p < .01) compared to polysexual individuals. However, not straight monosexual individuals had more than three times the odds of ever experiencing threats of being outed from a partner (OR = 3.62, p < .001) and two times the odds of gender belittlement (OR = 2.15, p < .01) compared to polysexual individuals.

Race and geographic region

Race and geographic region were not significant across any of the models.

Discussion

Our study findings showed significant differences across gender, age, sexual orientation, and experience of homelessness as related to likeliness of experiencing physical, sexual, and emotional IPV. Notably, rates of IPV were high, such that almost one-third (29.1%) of participants reported past physical IPV and over one-third (33.5%) reported sexual IPV. While the rate of physical IPV among our TGD sample was comparable to recent prevalence estimates among U.S. married/cohabiting cisgender adult women, the sexual violence rate was double that of this group (Bott et al., 2019). These rates are similar to and somewhat higher than those found in other studies conducted with TGD persons (King et al., 2019; Peitzmeier et al., 2020). Notably, we documented various forms of trans-specific emotional IPV, finding that almost one-fifth (17.5%) of those sampled had been threatened to be outed by a partner. This is incredibly important as being outed can increase risk of violence, as well as other negative outcomes (e.g., job loss, financial insecurity), due to the pervasiveness of anti-trans stigma (White Hughto et al., 2015). Moreover, almost one-quarter (23.7%) had their gender belittled by a partner. This is also a critical finding, as interpersonal anti-trans stigma—specifically a lack of gender affirmation—can have manifold negative mental health impacts on TGD persons (Glynn et al., 2016; Sevelius et al., 2020). It is possible that these rates were higher here in that we asked about specific types of IPV, rather than more general questions, and that people are becoming more aware of and less stigmatized around speaking about IPV than previously.

Our community-based study supported participants to self-identify (in writing) their genders. As such, one of our gender categories, called additional genders, captured those with multiple genders and/or identities that vary from more common language use, such as bigender, agender, demigender, and two-spirit. Reporting an additional gender was found to be a significant risk, particularly for emotional IPV. Similarly, nonbinary individuals were more than twice as likely to experience forced sex and three times as likely to be threatened to be outed by a partner. This is potentially in contrast with extant research indicating that nonbinary individuals tend to report lower lifetime experiences of IPV when compared to binary participants (Reisner & Hughto, 2019). Future studies are needed to further understand the reasons for such disparities, including qualitative research that can better understand some of the nuance across and within certain genders and their experiences.

Sexual orientation was associated with different types of IPV in nuanced ways. While there is a fair amount of literature exploring experiences of IPV among monosexual not straight (i.e., gay and lesbian) and polysexual (bisexual and queer) individuals (Edwards et al., 2015; Rollè et al., 2018), and some exploring the intersection of gender and sexual orientation among the experiences of IPV with young people (Atteberry-Ash et al., 2020; Walls et al., 2019), there is a need for more research exploring the experiences of IPV among TGD adults who hold marginalized sexual orientations.

We found that older age was associated with increasing risk of physical violence from an intimate partner. This is likely partly due to living longer meaning there is more time to have been exposed to IPV. Regardless, extant studies have shown that older trans people are at increased risk of violence, due to the intersection of anti-trans stigma and ageism (Messinger & Roark, 2019).

Finally, we found alarming risks of all types of IPV among those experiencing homelessness—a group that had five and a half times the odds of ever experiencing physical IPV, and approximately three times the odds of sexual and emotional IPV. There is a substantial body of evidence to suggest increased risks of violence among those experiencing homelessness (James et al., 2016; Montgomery et al., 2017). Moreover, with respect to IPV, housing precarity has been associated with needing to stay in a violent relationship for survival (Pavao et al., 2007). These alarming rates can be understood clearly through syndemic theory, which posits that the various social determinants of health interact synergistically to exacerbate each other and produce new health problems (Wirtz et al., 2020). Sydemic theory has been used frequently to look at HIV risk and rates among TGD individuals, and can be applied in this case as a way to look at the relationship between IPV, experiences of homelessness, and TGD identity.

Implications

Findings from this study have implications for both preventing experiences of IPV against TGD individuals, as well as supporting TGD people when such experiences do happen. First, it is important that individuals and organizations have a more inclusive understanding of the nuanced experiences of IPV, even within the larger TGD community. Many existing IPV prevention and support programs have a one-size-fits-all approach, which may further marginalize TGD individuals, especially those who hold multiply marginalized identities, and/or are at different points in their lives. These approaches may use traditional violence prevention models that are developed and validated on cisgender, heterosexual individuals, and have portions that are simply not relevant to TGD individuals, or give examples that do not feel accurate, such as case studies of cisgender men perpetrating violence against cisgender women, or suggestions for shelters that are not trans affirming. Previous research have found differential rates of discrimination in domestic violence shelters and rape crisis centers for TGD individuals based on race, ethnicity, and disability status (Kattari et al., 2017a; Kattari et al., 2017b). The more intersectional and trans affirming we can make organizations that address IPV related issues, the better we can support members of this population. The first step could be to include TGD individuals, communities, and organizations in the development of programs and policies.

Additionally, existing policies, at organizational, local, state, and national levels, need to be reworked to be more supportive of TGD individuals. Policies in domestic violence shelters, rape crisis centers, and other similar places must not only be TGD affirming but must also take intersecting identities into consideration. Organizations must be intentional in developing policies that include trans women in women’s spaces, trans men in men’s spaces, and in ensuring there are inclusive and supportive spaces for nonbinary individuals. Many TGD individuals have experienced discrimination and victimization in domestic violence shelters and rape crisis centers (Kattari et al., 2017a; Kattari et al., 2017b, Peitzmeier et al., 2020), exposing a need for improvement in practices that are inclusive of this population. Having Spanish and ASL interpreters, available to best serve TGD individuals who need these services will also help support members of this population. Local, state, and national governments need to create or update policies to ensure trans people of all genders are included in anti-violence legislation. These policies should also include robust sexual orientation and gender identity questions being collected on state health surveys, and money for TGD inclusive interventions being apportioned to health departments and prevention programs.

Finally, mental health professionals should have more inclusive and intersectional approaches to working with survivors of IPV from the TGD population, especially given previous issues related to TGD specific discrimination in mental health settings that differ across disability status and race (Kattari et al., 2017a; Kattari et al., 2017b). Realizing that there are specific forms of IPV that may be unique to this population, such as outing someone or withholding gender affirming medications and/or clothing items and accessories, will allow practitioners to better identify experiences that might look different than in cisgender populations. Thinking intentionally about the resources they have to share with their clients, to make sure that the resources are trans inclusive and affirming, is another way to better prepare for potential or current clients. Connecting with other mental health professionals to share resource lists, referrals, continuing education training, and advocacy opportunities allows individual professionals to keep more up-to-date on the best ways to support their clients. Moreover, these findings suggest that all providers who support IPV survivors (which is a considerable range of disciplines, including and extending well beyond advocates and therapists) receive training on these topics.

Limitations

As with all studies, there are limitations to this study. Firstly, this study uses cross-sectional data. Therefore, our findings represent only a snapshot in time, instead of a deeper look at how different sociodemographic characteristics may be connected to various experiences of violence. Given the sample size of 659, we had to collapse several robust sociodemographic categories together for the purpose of our analyses. One solution to this challenge is for larger census or representative population surveys (that collect data on everything from health to experiences of violence) to have a larger variety of response choices for all identity variables (such as race and ethnicity, gender, sexual orientation, etc.). The purpose of this would be for larger sub-samples which would allow more nuance categories that would not require collapsing before analysis. Additionally, although this sample mirrored the racial breakdown of Michigan, the sample itself was 76.5% White. There continues to be a need for increasingly diverse samples of TGD individuals to allow for a deeper understanding of the unique experiences of TGD people of color. Additional research must work to intentionally recruit more individuals of color, using a plan oversample, which would result in the potential for more nuanced analyses. The bi-variate analysis itself is also a limitation, particularly given an interest in intersectional approaches, and future research should aim for larger and more diverse samples to conduct more robust analyses.

Finally, we recognize that our operationalization of IPV, consistent with the Centers for Disease Control and Prevention (2020), diverges from how some anti-violence advocates understand IPV. More specifically, anti-violence advocates typically conceptualize IPV as a pattern of controlling behaviors, characterized by a one-directional abusive dynamic, rather than any incident, which allows for one- or bi-directional abuse. Future studies may consider taking a more thorough approach to operationalizing IPV consistent with IPV interpersonal and advocacy practice.

Conclusion

Issues of IPV impact all types of individuals, and this impact is different across identities and sociodemographic realities. Even within TGD individuals, research indicates differential rates of emotional, physical, and sexual IPV, and multivariate models show significant findings across age, gender, sexual orientation, and experiences of homelessness. Social service professionals who work in the field of violence prevention and/or with survivors of violence should ensure that their programs, centers, and policies are not only affirming of TGD individuals, but also are prepared to meet the unique intersecting needs of the TGD population—in particular, reducing the rates of IPV and supporting survivors after IPV occurs.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Shanna K. Kattari

Ashley Lacombe-Duncan

Author Biographies

Shanna K. Kattari is an assistant professor at the University of Michigan School of Social Work and Department of Women’s and Gender Studies. Their mixed methods and intersectional research focuses on three areas; 1) gender and cissexism, 2) sexuality and sexual health, and 3) disability and ableism. Dr. Kattari is interested in creating affirming health spaces for people of all identities and experiences.

Leo Kattari is a social work doctoral student at Michigan State University. He has over a decade of experience in the areas of health education, organizational development, community change, and advocacy. Leo’s research focus is on health equity and policy across the lifespan, specifically focusing on TGD community change strategies for health and wellness.

Ashley Lacombe-Duncan is an Assistant Professor at the University of Michigan School of Social Work and Adjunct Scientist at Women’s College Research Institute, Toronto, Canada. She conducts mixed methods research focused on understanding barriers to access to care for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people and developing/adapting, pilot testing and evaluating interventions to increase care engagement.

Jama Shelton is an associate professor at the Silberman School of Social Work, Hunter College. Their community-based research focuses on experiences of housing instability and homelessness among LGBTQ youth and young adults, and the systemic barriers to housing stability for trans and gender expansive people. Dr. Shelton is interested in moving the social work profession beyond binary constructs of gender, sexuality, risk, and resistance.

Brayden Misiolek is co-founder of a trans-led non-profit organization, Transcend the Binary. Transcend’s mission is to empower the trans and gender diverse community through access to affirming care, resources, and education, while promoting health through an integrative approach to wellness (physical, mental, social). His specialized focus is on community-led research and evaluating as well as identifying opportunities for community programs.

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