The transgender-specific intimate partner violence scale for research and practice: Validation in a sample of transgender women

https://doi.org/10.1016/j.socscimed.2021.114495Get rights and content

Highlights

  • Transgender people are at elevated risk of intimate partner violence (IPV).

  • IPV can take on trans-specific dimensions, e.g. the abuser threatening to out a partner.

  • We developed an 8-item scale to screen for trans-specific IPV (T-IPV).

  • Our scale shows strong reliability and construct validity.

  • Our scale can be used to screen and refer trans individuals for IPV services.

Abstract

Study/research objective

To develop and validate a brief intimate partner violence (IPV) scale that screens for controlling behaviors and psychological abuse tactics directed toward transgender individuals.

Rationale

Transgender individuals are at elevated risk of physical and sexual IPV compared to cisgender individuals. IPV often takes on unique dimensions against transgender individuals, such as when an abusive partner threatens to “out” the transgender person, or use other tactics that weaponize transphobia within the relationship. Standard IPV screeners do not assess this type of transgender-specific IPV (T-IPV).

Methods

Between March 2018 and October 2019, a T-IPV scale was tested in two samples (in-person and online) of transfeminine adults (i.e. assigned a male sex at birth and identify with femininity) from the eastern and southern U.S. Exploratory factor analysis (EFA) was conducted with the in-person sample (N = 661) to assess construct validity. Confirmatory factor analysis (CFA) was then used in an independent online sample (N = 481). Using the combined sample (N = 1137), convergent validity was assessed using correlations with other forms of victimization. Multivariable regression models were fit to estimate the relationship between T-IPV and health outcomes.

Results

Factor analyses yielded an 8-item unidimensional scale with moderate to good fit. Nearly half the sample (48.7%) experienced at least one scale item. Internal consistency reliability was strong (KR-20 = 0.827). Significant correlations with other forms of victimization indicated convergent validity. Lifetime T-IPV was significantly associated with psychological distress (adjusted prevalence ratio [aPR] = 1.32, 95% CI = 1.13, 1.53), PTSD (aPR = 1.50, 95%CI = 1.31, 1.72), alcohol abuse (aPR = 1.21, 95%CI = 1.01, 1.44), and drug use disorder (aPR = 1.30, 95%CI = 1.06, 2.59).

Conclusions

This T-IPV scale is a reliable and unidimensional measure with strong construct validity. T-IPV is independently associated with mental health burden and substance use. Service providers working with transgender clients should screen for T-IPV to avoid missing cases of IPV, and refer to violence response services.

Introduction

Intimate partner violence (IPV) involves physical, sexual, or psychological harm perpetrated against an individual by a current or former partner or spouse (Black et al., 2011). A recent systematic review found that transgender individuals – individuals who identify as a gender different than the sex they were assigned at birth – are at 2.2 times the risk of physical IPV, and 2.5 times the risk of sexual IPV, as compared to cisgender (i.e., non-transgender) individuals (Peitzmeier et al., 2020). Transgender individuals' heightened vulnerability to IPV is likely because abusive partners are able to leverage societal transphobia as a tool of power and control within the relationship. For instance, qualitative evidence with transgender individuals finds that abusers may control their partner's actions or blackmail them into unwanted sex by threatening to “out” them as transgender to their family, their coworkers, or simply to passers-by when out in public (Guadalupe-Diaz, 2013). Knowing that this type of victimization can lead to loss of social support or employment, as well as threats to physical safety (Hughto et al., 2015), transgender individuals may be forced to comply with an abuser's wishes. Abusers may also undermine the partner's sense of self-worth and confidence by critiquing their every action as not the way a “real” man or woman would behave or act. These trans-specific tactics have been linked to increased mental health burden for survivors (Peitzmeier et al., 2019). In other work with lesbian, gay, bisexual, transgender, or queer (LGBTQ) individuals more broadly, LGBTQ individuals who experienced IPV targeting their sexual and/or gender identity are also more likely to seek housing, mental health services, medical care, and support services than those who experience psychological abuse not specific to their identity, supporting the idea that identity-related IPV can be particularly damaging and require a higher level of support (Scheer and Baams, 2019).

Transgender women, especially transgender women of color, may face particular risks for IPV because of harmful societal stereotypes that specifically position trans women as hypersexual and stigmatize cisgender men who have relationships with transgender women (Gamarel et al., 2020). There is evidence to suggest that coercive control, violence, and even homicide perpetrated by cis male partners of transgender women is often to conceal the stigmatized relationship from other people. Further, transgender women feel pressure to engage in relationships with some men that they would not otherwise choose to partner with, for fear that these men may turn violent if rejected, or alternatively out of an internalized belief that they will not find other partners (Gamarel et al., 2020). Higher levels of economic precarity, discrimination in employment, and family rejection among trans women as compared to cisgender women (James et al., 2016) also increase dependency on abusive partners for economic or social support.

Common scales and screeners for IPV such as the Revised Conflict Tactics Scale (CTS-2) were originally developed and validated in samples of predominantly heterosexual cisgender women (Straus et al., 1996). These scales are considered behavioral measures in that they ask about specific abusive behaviors perpetrated against the individual such as being hit, punched, or slapped. Behavioral measures are advantageous because they do not require an individual to label their experience as abuse in order to report experiencing IPV. Because many survivors minimize abuse and do not label their experiences as abusive per se, behavioral measures are widely used in IPV research and service provision (Basile et al., 2007).

Yet, existing behavioral IPV measures developed with cisgender women are problematic when applied to transgender populations. Research finds that many abusers preferentially use trans-specific abuse tactics, as their power is reinforced by the weight of societal transphobia (Guadalupe-Diaz, 2013). Existing IPV measures fail to screen for these most commonly used abuse tactics that are unique to the experiences of transgender people; thus, they are likely insufficiently sensitive as IPV screening tools for transgender populations. Low sensitivity in practice or clinical settings can result in transgender survivors being incorrectly “screened out,” deprioritized for services, denied services, or never offered services for IPV in the first place.

Researchers have made efforts to address this gap by developing behavioral scales that include transgender-specific tactics. The US Trans Survey (USTS; N = 27,715 transgender individuals) found that 27% of participants had experienced some kind of transgender-specific IPV in their lifetime as measured by three questions: their partner had prevented them from accessing hormones (3%), told them that they were not a “real” woman or man (25%), or threatened to “out” them as transgender (11%) (James et al., 2016). Garthe and colleagues included two trans-specific items in a larger IPV scale administered to young transgender women, which focused on lifetime coercive control of gender presentation (18%) and belittling a partner due to their transgender identity (22%) (Garthe et al., 2018). Peitzmeier et al. (2019) developed a 4-item transgender-specific IPV (T-IPV) scale and piloted it in a sample of 150 transmasculine individuals (i.e., individuals assigned a female sex at birth who identify their gender on a spectrum of masculinity). Their measure had good convergent and divergent validity, but only moderate reliability (as well as incomplete domain coverage) given the small number of items (Peitzmeier et al., 2019). Woulfe and Goodman (2018) developed a 7-item scale of “identity abuse” meant to be used by LGBTQ individuals broadly, and tested it in a sample of 734 LGBTQ individuals, including 142 transgender people. Woulfe and Goodman found that 40.1% reported any identity abuse in adulthood, with individual item frequencies ranging from 6.3% (“the person threatened to tell my employer, family, or others about my sexual orientation or gender identity”) to 28.3% (“the person questioned whether my sexual orientation or gender identity was ‘real’”) (Woulfe and Goodman, 2018). Further, transgender participants in their sample were more likely than cisgender participants to experience identity abuse, consistent with the hypothesis that transgender individuals are particularly vulnerable to identity-specific IPV. Similarly, Dyar and colleagues developed a 5-item IPV scale for LGBTQ individuals that focused on outing, social isolation, and pressuring someone to stay in a relationship by telling them no one else would ever love them due to their LGBTQ identity (Dyar et al., 2019). However, the items in both of these scales were not truly transgender-specific as they were developed to be relevant across the range of identities and experiences in the LGBTQ community. As such, these LGBTQ-focused measures lack domain coverage and content validity for transgender individuals by not being able to include common abusive behaviors directed against transgender people specifically, such as partners sabotaging gender transition or belittling gender expression.

The current study builds on this existing work by developing and validating a transgender-specific IPV scale that screens for abuse tactics directed against transgender people and piloting a potential 10-item scale with transfeminine adults (i.e., individuals assigned a male sex at birth who identify their gender along the feminine gender spectrum, including but not limited to transgender women). We chose to continue focusing on transgender-specific IPV, rather than LGBTQ-related IPV broadly as in Woulfe and Goodman's or Dyar et al.’s work, because this allows for the inclusion of items that are not relevant to cisgender LGBQ individuals, such as hiding and/or sabotaging hormones by a partner. Further, qualitative evidence suggests that abusers may use abuse tactics related to gender identity even more commonly than tactics related to sexual orientation, because of the centrality of gender to identity and because transgender identities are even more stigmatized than sexual minority identities (Guadalupe-Diaz, 2013). As stated by Woulfe and Goodman, “At its heart, [identity abuse] involves the exploitation of a target's vulnerabilities by attacking their most oppressed identities. It makes sense then, that the greater the stigma attached to an identity, the greater the risk of [identity abuse]” (Woulfe and Goodman, 2018). Naming these transgender-specific tactics is therefore critical for IPV screening in transgender populations.

Section snippets

Study overview and data collection

Participants were enrolled as part of the American Cohort To Study HIV Acquisition Among Transgender Women (known to participants and the community as the LITE study) (Wirtz et al., 2019). LITE is a multi-site prospective cohort examining HIV acquisition and other health outcomes among transfeminine adults in the Southern and Eastern US across 24-months. Participants contributing data to this analysis completed a baseline assessment between March 22, 2018 and October 22, 2019 (n = 1137). Adult

Results

Lifetime prevalence of each of the 10 T-IPV items ranged from 4.9% to 31.7%. (Table 1).

Discussion

This study demonstrates that the T-IPV scale is a reliable and unidimensional measure of partner controlling tactics that are specific to the experience of transgender individuals. The measure has strong construct validity, substantially building on a previous iteration of the scale that was tested in transmasculine individuals by including more items to increase content validity and reliability, and undergoing rigorous psychometric validation in a large sample of transfeminine adults. Having

Conclusion

This eight-item scale can be used to assess a unique and impactful form of psychological and controlling forms of T-IPV experienced among transgender populations, which is correlated with but distinct from physical and sexual IPV. The measure can be used to screen for abuse tactics directed against transgender survivors in clinical and research settings, filling a key gap in existing tools to accurately assess IPV against transgender people. The high prevalence of lifetime T-IPV found in this

Credit author statement

Sarah Peitzmeier: Conceptualization, Methodology, Writing – original draft, review and editing, design of data analysis, Visualization, Supervision of data analysis, creation of the original scale. Andrea Wirtz: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, review and editing. Elizabeth Humes: Data curation, Formal analysis, Visualization, original draft of methods. Jaclyn Hughto: creation of original scale,

Declaration of competing interest

None.

Acknowledgements

The authors express their gratitude to the transgender women who take part in this study; the study would not have been possible without their participation. Research reported in this publication was jointly supported by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the National Institute of Child Health and Human Development of the National Institutes of Health under Award Number UG3AI133669 (Wirtz/Reisner). Research reported in this

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