Arch Sex Behav (2006) 35:685–697 DOI 10.1007/s10508-006-9108-5
ORIGINAL PAPER
Gender Nonconformity and Psychological Distress in Lesbians and Gay Men W. Christopher Skidmore · Joan A. W. Linsenmeier · J. Michael Bailey
Received: 23 December 2005 / Revised: 10 July 2006 / Accepted: 28 July 2006 / Published online: 16 November 2006 C Springer Science+Business Media, LLC 2006
Abstract Some lesbians and gay men tend to be more gender nonconforming, on average and for certain traits, than their heterosexual counterparts. Gender nonconformity in childhood has also been linked to adult homosexuality. Studies of both lesbians and gay men also find elevated rates of psychological distress. We hypothesized that these facts may be related. Individuals who violate social norms for genderappropriate behavior may suffer from stigmatization by both heterosexual and homosexual people, leading to higher levels of psychological distress. We examined whether several measures of gender nonconformity were related to psychological distress in a community-based sample of gay men and lesbians. These included self-reports of childhood and adulthood gender nonconformity, as well as observer ratings of current behavior. Several measures of gender nonconformity were related to each other for both lesbians and gay men. In addition, gender nonconformity was related to psychological distress, but only for gay men. Finally, both lesbian and gay male participants reported more positive attitudes towards gender conformity than nonconformity, although the pattern was somewhat different for each group. We discuss the implications of these results for future studies of gender nonconformity and for the promotion of psychological health in lesbians and gay men. Keywords Gender nonconformity . Homosexuality . Psychological distress . Depression . Stigmatization W. C. Skidmore () · J. A. W. Linsenmeier · J. M. Bailey Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, Illinois 60208-2710, USA e-mail:
[email protected]
Introduction On average and in certain respects, homosexual adults tend to be more gender nonconforming, or sex-atypical, than their heterosexual peers. For example, some lesbians and gay men report occupational and hobby interests that are more typical of the opposite sex (Lippa, 2000, 2002; Pillard, 1991). They also show more gender nonconformity in traits such as voice, movement, and appearance (Ambady, Hallahan, & Conner, 1999; Bailey, 2003). Homosexual people also tend to have been more gender nonconforming as children. The typical playstyles and behavior of girls and boys differ in important ways. For example, young girls often play with dolls and act out family roles, while boys tend to engage more in rough-and-tumble play that emphasizes themes of dominance and competition (Maccoby, 1998). Thus, childhood gender nonconformity consists of behaviors such as rough-and-tumble play in girls or a preference for playing with dolls in boys. In a meta-analysis of studies on this topic, Bailey and Zucker (1995) found that homosexual adults on average reported more childhood gender nonconformity than heterosexual adults. These findings have been replicated across cultural groups (Lippa & Tan, 2001; Whitam, 1983; Whitam & Mathy, 1986, 1991). In addition, prospective studies have confirmed that very feminine boys tend to become gay men (Green, 1974, 1987; Zucker, 1990), and recent evidence suggests that very masculine girls also tend to become lesbians at higher-than-expected rates (Drummond, 2006). Although gender nonconformity and sexual orientation appear to be related, not all lesbians and gay men are gender nonconforming. For example, not all gay men report that they were feminine boys (Bailey & Zucker, 1995). Also, some researchers argue that the majority of gay men, even those who were very feminine boys, defeminize as they Springer
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reach adulthood, primarily as a reaction to persistent social pressure (Bell, Weinberg, & Hammersmith, 1981; Harry, 1983a, 1983b; Landolt, Bartholomew, Saffrey, Oram, & Perlman, 2004; Saghir & Robins, 1973; Taywaditep, 2001; Whitam, 1977). Moreover, many lesbians and gay men report sex-typical behavior and interests (Bailey, Kim, Hills, & Linsenmeier, 1997; Bailey & Zucker, 1995; Friedman & Downey, 1999). Thus, the relationship between gender nonconformity and sexual orientation, although documented in many studies, is complex and not yet fully understood. Sexual orientation and psychological distress In addition to its relationship with gender nonconformity, sexual orientation has been linked to measures of psychological distress (Cochran & Mays, 2000a, 2000b; Fergusson, Horwood, & Beautrais, 1999; Paul et al., 2002). Studies have found that gay men have increased rates of depression, anxiety disorders, and suicidal behavior compared with heterosexual men (Bancroft, Janssen, Strong, & Vukadinovic, 2003; Fergusson et al., 1999; Remafedi, French, Story, Resnick, & Blum, 1998; Sandfort, de Graaf, Bijl, & Schnabel, 2001). The National Comorbidity Survey also found support for the association between a homosexual sexual orientation and increased risk for anxiety, mood, and substance abuse disorders as defined by DSM-III-R criteria, as well as increased risk for suicidal thoughts and plans (Gilman et al., 2001). Other studies have supported the link between homosexual orientation and suicidality, in terms of higher rates of suicidal ideation and completed suicides, even at young ages (de Graaf, Sandfort, & ten Have, 2006; Lebson, 2002; Paul et al., 2002; Russell & Joyner, 2001). Studies in this area have typically focused more on the mental health of gay men, but some studies including lesbian samples have yielded similar results (Fergusson et al., 1999; Gilman et al., 2001; Sandfort et al., 2001). Thus, identifying the causes and correlates of psychological distress in homosexual samples remains an important area of study. Gender nonconformity and psychological distress As members of a stigmatized minority group, some lesbians and gay men may experience verbal and physical abuse, discrimination, rejection, political intolerance, victimization, and hate crimes despite (and perhaps because of) increased visibility in recent decades (Herek, 1991, 1992; Herek, Gillis, & Cogan, 1999; Hershberger & D’Augelli, 1995; King & Bartlett, 2006). For example, several large national surveys of adult lesbians and gay men in the United States have documented lifetime rates of sexuality-based verbal harassment ranging from 52% to 91%; many investigations find that a
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higher percentage of gay men than lesbians experience such verbal abuse (Berrill, 1992). Rates of threatened physical violence in such studies range from 24% to 48%, typically demonstrating a similar gender difference (Berrill, 1992). However, other investigations have found that lesbians experience more lifetime victimization than gay men, possibly due to greater rates of childhood sexual abuse and adult sexual assault (Balsam, Rothblum, & Beauchaine, 2005). Thus, sex differences in victimization of lesbians versus gay men may depend partially on the type of victimization measured. Aside from specific instances of victimization, homosexual individuals generally are raised in what has been called a “culture of bias” (Friedman & Downey, 1999, p. 326), which may reinforce their stigmatized status further. Research suggests that discrimination based on minority group membership can increase risk for psychological distress through a variety of processes (Huebner, Nemeroff, & Davis, 2005; Mays & Cochran, 2001; Sandfort et al., 2001). These include direct experiences of victimization and rejection; however, even more subtle perceptions of discrimination may be related to increased psychological distress (e.g., Kessler, Mickelson, & Williams, 1999). Most relevant here, stigmatization appears to have significant affective, cognitive, and behavioral consequences for lesbians and gay men (Mays & Cochran, 2001; Meyer, 1995, 2003; Ross, 1990; Savin-Williams, 1994). Negative attitudes toward lesbians and gay men may be related to decreased social support, which can serve as a buffer against the negative consequences of stressful experiences (e.g., Cohen, Gottlieb, & Underwood, 2000; Helgeson, 2003; Wills, 1998). Finally, even the vicarious experience of victimization or the anticipation of negative social reactions may cause significant stress and mental health problems for some lesbians and gay men (Balsam et al., 2005; Herek & Berrill, 1992; Meyer, 1995, 2003). Gender nonconformity may partly mediate the relationship between sexual orientation and psychological distress. Zucker (1994) suggested that particularly gender nonconforming individuals may be most at risk for stigmatization. Gender nonconforming homosexual individuals may more often be labeled as lesbian or gay, increasing their visibility as targets for victimization. In fact, heterosexual people do tend to expect lesbians to be masculine and gay men to be feminine (Haddock, Zanna, & Esses, 1993; Kite & Deaux, 1987; Madon, 1997; Martin, 1990; Page & Yee, 1985), and some lesbian and gay adolescents may monitor and modify cues of gender nonconformity in order to hide or reveal their sexual orientation (Lasser & Tharinger, 2003). Furthermore, gender nonconforming people may be ostracized simply for violating gender norms, over and above any implication that they are more likely to be homosexual (Herek, 1991; Laner & Laner, 1979; Laner & Laner, 1980; Storms, 1978; Whitley,
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1987). For example, gender nonconformity in men may be interpreted as weakness (Haddock & Zanna, 1998; Theodore & Basow, 2000; Tomsen, 2002). If gender nonconforming lesbians and gay men are subject to greater stigmatization, they may, as a consequence, experience greater psychological distress than gender conforming homosexual people. In addition to heterosexuals’ negative attitudes towards gender nonconformity, some evidence suggests that, on average, lesbians and gay men themselves have negative attitudes towards gender nonconformity. For example, several studies of the personals ads of lesbians and gay men have suggested that they prefer sex-typical romantic partners (Bailey et al., 1997; Bell & Weinberg, 1978; Laner, 1978; Laner & Kamel, 1977, Laner & Laner, 1979, 1980). Negative attitudes within lesbian and gay communities may contribute additional problems for gender nonconforming women and men (Bailey et al., 1997; Taywaditep, 2001). Stigmatization of gender nonconformity also occurs at other developmental stages. Gender nonconforming children, particularly feminine boys, may suffer ridicule and rejection by peers and parents early in childhood (Bailey, 2003; Beard & Bakeman, 2000; Carter & McCloskey, 1983; Fagot, 1977, 1995; Green, 1987; Landolt et al., 2004; Maccoby, 1998; Saghir & Robins, 1973; Smith & Leaper, 2005; Zucker, Wilson-Smith, Kurita, & Stern, 1995). For example, extremely feminine boys referred to clinics for treatment of gender identity issues have been found to exhibit significant difficulties with peer relationships and rejection (Cohen-Kettenis, Owen, Kaijser, Bradley, & Zucker, 2003; Fridell, 2001; Green, 1976; Zucker, Bradley, & Sanikhani, 1997). Non-clinic populations may face similar problems (Carver, Egan, & Perry, 2004; Carver, Yunger, & Perry, 2003; Egan & Perry, 2001; Yunger, Carver, & Perry, 2004). A general asymmetry in the strength of gender boundaries for girls versus boys may contribute to these findings. Young boys reject other boys who act in feminine ways, but girls are generally accepting of other girls’ tomboyish behavior. Similarly, parents (especially fathers) tend to be more concerned about gender nonconformity in their sons than in their daughters (Fagot, 1995; Friedman & Downey, 1999; Kane, 2006; Maccoby, 1998). Maccoby (1998) further noted that an essential element in boys becoming acceptably “masculine” appears to be becoming “not feminine,” while girls do not have to go through as rigorous a process of other-gender devaluation to be acceptably feminine. This discrepancy in tolerance of gender nonconformity in girls versus boys may continue into adulthood. The rejection that many lesbians and gay men may have faced as children because of their gender nonconformity could plausibly affect their development in important ways (e.g., Beard & Bakeman, 2000; Landolt et al., 2004). For example, Friedman and Downey (1999, 2002) described a
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complex process whereby stigmatization of childhood gender nonconformity may become linked to adult psychological distress for some gay men. They argued that gay men are especially likely to experience, and to be negatively affected by, stigmatization of childhood gender nonconformity. This stigmatization of their femininity, most often by other males, may become internalized and tied to their homosexual identity, causing some to develop internalized homophobia with an additional element of “gender-values self-condemnation” (Friedman & Downey, 1999, p. 327). They further argued that a similar process does not happen for gender nonconforming heterosexual men. Some evidence does support the hypothesis that gender nonconformity may be associated with increased risk for psychological problems, at least for gay men. Bailey and Zucker (1995) reviewed several studies finding an association between childhood gender nonconformity and adult psychological distress in gay men. Psychological problems in adulthood associated with recalled childhood gender nonconformity include lower self-esteem, higher rates of mood and anxiety disturbances, and suicidality (Harry, 1983a, 1983b; Weinrich, Grant, Jacobson, Robinson, & McCutchan, 1992, Weinrich, Atkinson, McCutchan, & Grant, 1995). Gender nonconformity may also be associated with increased risk for suicide attempts in gay adolescents (Remafedi, 1999). In contrast, studies of lesbians do not reliably find similar associations (e.g., Harry, 1983b). Bailey and Zucker (1995) suggested that this pattern might be due to greater mistreatment of feminine boys by parents and peers. Similarly, although adult gender nonconformity may be linked to negative treatment for gay men, at least some aspects of more typically masculine behaviors or interests may actually benefit women (Impett, Schooler, & Tolman, 2006; Oliver & Toner, 1990; Thornton & Leo, 1992; Wong, Kettlewell, & Sproule, 1985). The current research measured the relationships among several aspects of gender nonconformity and psychological distress in a sample of lesbians and gay men. In addition to assessing recollections of gender nonconformity in childhood, we also measured participants’ current occupational and hobby interests and the degree to which they thought of themselves as relatively feminine or masculine. Furthermore, we collected observer ratings of participants’ degree of gender nonconformity based on a brief videotaped interview. We examined correlations among the various measures of gender nonconformity. Next, we examined relationships between measures of gender nonconformity and psychological distress. We hypothesized that gender nonconformity would be positively correlated with psychological distress, particularly in gay men. In addition, we hypothesized that lesbians and gay men in our sample would report negative attitudes towards gender nonconformity.
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Method Participants A total of 44 lesbians and 50 gay men were recruited using advertisements in Chicago community publications. Separate advertisements requesting lesbians and gay men for “a study about masculinity and femininity,” with the promise of compensation, were placed in Chicago area newspapers. Some publications targeted gay, lesbian, bisexual, and/or transsexual populations, but we also advertised in a free local newspaper available throughout the city and on an internet website listing local classifieds and advertisements, both of which are intended for the general public. Mean ages for female and male participants were 31 (SD = 9.3) and 35 (SD = 9.0) years, respectively. Of the lesbians, 52.4 percent were Caucasian, 31 percent African American, 7.1 percent Hispanic, 2.4 percent Asian, and 7.1 percent reported an “other” ethnic group membership; of the gay men, 52 percent were Caucasian, 30 percent African American, 12 percent Hispanic, 2 percent Asian, and 4 percent reported an “other” ethnic group membership. Participants reported on educational level on the following scale: “1 = no high school, 2 = some high school, 3 = high school graduate, 4 = some college or trade school, 5 = college graduate, 6 = some postgraduate work, and 7 = graduate degree.” Median responses were “some college or trade school,” and “college graduate” for women and men, respectively. Participants also reported on their relationship status; 77.5% of women and 25% of men reported currently being in a serious relationship. Measures Gender nonconformity Participants completed three measures of self-reported gender nonconformity. The seven-item Childhood Gender Nonconformity Scale (CGNS; Bailey & Oberschneider, 1997) was used to assess the degree of gender nonconformity of participants’ recalled childhood behavior. There were two versions (one for men and one for women), and participants rated their agreement with items on a 5-point scale (1 = strongly disagree; 5 = strongly agree). Responses were summed with higher scores indicating more gender nonconformity. The version for women included statements such as, “As a child, I was called a tomboy by my peers,” and “I was a masculine girl,” and the version for men included statements such as, “As a child, I was called a ‘sissy’ by my peers,” and “I was a feminine boy.” Coefficient alphas for the CGNS in this sample were .90 for women and .84 for men. Participants also completed three measures designed to assess current levels of gender nonconformity. The first two Springer
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were the Occupational Preferences and Hobby Preferences questionnaires (e.g., Lippa & Connelly, 1990). These scales have been used in previous research to measure gender diagnosticity, the “Bayesian probability that an individual is predicted to be male or female based on some set of genderrelated indicators” (Lippa & Connolly, 1990, p. 1051). The occupations and hobbies included in these questionnaires have been found to be generally more appealing either to women or to men in contemporary American society. Participants rated how much they liked or disliked various occupations, such as “football player” and “librarian,” and various hobbies, such as “going to car shows” and “romance novels,” using a 5-point scale (1 = strongly dislike; 5 = strongly like). Coefficient alphas for the Occupational Preferences scale in this sample were .92 for women and .94 for men. Coefficient alphas for the Hobby Preferences scale in this sample were .88 for women and .87 for men. Summed responses on the two scales were highly correlated for both lesbians (r = .61, p < .0001) and gay men (r = .77, p < .0001). As a result, responses to the two scales were standardized and added to form an “interests” composite variable, which was used in subsequent analyses. The 10-item Continuous Gender Identity Scale (CGIS; Bailey, Finkel, Blackwelder, & Bailey, 1998) was used to measure several aspects of participants’ subjective assessments of their current masculinity or femininity. Scores on this scale have been shown to correlate moderately with partners’ assessments of lesbians’ and gay men’s gender nonconformity (Bailey et al., 1998). There were two versions, one for women and one for men, and participants rated their agreement with items on a 5-point scale (1 = strongly disagree; 5 = strongly agree). Responses were summed with higher scores indicating more gender nonconformity. The version for women included statements such as, “I am much less masculine than the average lesbian,” and “I pride myself on being feminine,” and the version for men included items such as, “In many ways, I feel more similar to women than to men,” and “I don’t feel very feminine.” Coefficient alphas for the CGIS in this sample were .79 for women and .79 for men. Finally, a group of raters made observer ratings of gender nonconformity for participants who agreed to an optional videotaped interview at the beginning of the session. Two female undergraduates and one male undergraduate served as raters. Before rating actual study data, each rater underwent a brief training period in which he or she rated sample videos of women and men separately. Clips from popular media and from previous studies were used. After each rater had rated all of the training clips, they discussed them as a group, in order to reach consensus on use of the rating scales before rating the videos of actual participants. Each rater watched all clips of participants of one gender and then all clips of participants of the other gender. Using a
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7-point scale (1 = very feminine; 7 = very masculine), they rated each participant’s voice, movement, and appearance, as well as their “overall impression” of that participant. For the analyses, ratings for the men were reverse-scored, so that higher ratings for both women and men indicated a higher degree of gender nonconformity. Previous research using a similar approach showed that such observer ratings can distinguish reliably between homosexual and heterosexual participants (Rieger, Gygax, Linsenmeier, & Bailey, 2006). For ratings of lesbian participants, coefficient alphas were .73, .86, .81, and .88 for voice, appearance, movement, and overall impression ratings, respectively. For gay men, coefficient alphas were .84, .80, .80, and .84 for voice, appearance, movement, and overall impression ratings, respectively. Ratings of each dimension were standardized separately for each sex and then averaged to obtain four measures of observerrated gender nonconformity for each participant.
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using a 7-point scale (1 = strongly disagree; 7 = strongly agree). Responses were summed with higher scores on each subscale indicating more negative attitudes towards gender nonconformity in either women or men. Coefficient alphas for the butchphobia subscale were .86 and .91 for lesbians and gay men, respectively. Coefficient alphas for the femiphobia subscale were .84 and .93 for lesbians and gay men, respectively. Participants also responded to four “feeling thermometer” items (cf. Campbell, 1971) that assessed the degree to which participants generally liked gender nonconforming and conforming women and men. Participants were asked to provide a number between 0 and 100 to indicate their general liking of four groups of people: masculine women, feminine women, feminine men, and masculine men. For example, the “feminine men” item asked, “On a scale from 0 to 100, with 0 being not at all and 100 being extremely, how much do you like feminine men?”
Psychological distress Procedure Two scales assessed participants’ psychological health. Participants completed paper-and-pencil versions of the Beck Depression Inventory II (BDI-II; Beck & Steer, 1987) and the State-Trait Anxiety Inventory (STAI; Spielberger, 1983). The BDI-II assesses the amount and degree of current depressive symptoms. Total scores can range from 0 to 63, with higher scores indicating the presence of more depressive symptoms. Coefficient alphas for the BDI in this sample were .83 and .90 for women and men, respectively. The STAI consists of two scales designed to assess symptoms of anxiety. The “state” scale consists of 20 statements that measure how participants report feeling “right now, that is, at this moment,” and the “trait” scale consists of 20 statements that measure how participants report feeling “generally.” Responses to each part of the scale were summed to provide a state anxiety index and a trait anxiety index, with higher scores indicating higher levels of state and trait anxiety. Coefficient alphas for the state scale were .94 and .95 for lesbians and gay men, respectively, and coefficient alphas for the trait scale were .93 and .95 for lesbians and gay men, respectively. Attitudes towards gender nonconformity Participants completed two measures of attitudes towards gender nonconformity. The first was a 50-item Attitudes Towards Gender Nonconformity Scale designed by the researchers to measure butchphobia, or attitudes towards masculine or “butch” women, and femiphobia, or attitudes towards feminine men. Participants rated their degree of agreement with items such as, “I like feminine lesbians more than masculine lesbians,” on the butchphobia subscale and “Feminine men disgust me” on the femiphobia subscale
Participants completed the study individually in a private room. Participants were first offered the option to participate in a videotaped interview. Consenting participants answered an open-ended question about their thoughts on the issue of coming out, and spoke for an average of about three to five minutes. At the end of the interview, the researcher moved participants to a desk and handed them paper copies of the BDI-II and STAI. The researcher reminded participants of the confidentiality of responses and then left them alone in the room to complete the questionnaires. The researcher returned to the room when participants had completed the psychological distress measures, collected them, and started the computer program that presented the remaining measures. Participants completed these measures in private, including demographic questions about age, ethnic background, education, and relationship status. Finally, the researcher returned to the room, debriefed participants, thanked them, and gave them a check for $20. After all participants had completed the study, the undergraduate raters watched the videotaped interviews of participants. They rated each participant on the four dimensions of observer-rated gender nonconformity as described above.
Results The majority of participants, or 32 (72.7%) of the lesbians and 35 (70%) of the gay men, agreed to be videotaped. For both women and men, there were no significant differences between participants who did or did not agree to be videotaped in self-reported gender nonconformity, butchphobia, femiphobia, or psychological distress (all ps > .10). Springer
690 Table 1 lesbians
Arch Sex Behav (2006) 35:685–697 Correlations among measures of gender nonconformity (GN), attitudes toward gender nonconformity, and psychological distress for Childhood Adult ObserverGN CGI Interests rated GN
Self-rated GN Childhood GN Adult continuous gender identity (CGI) Interests Observer-rated GN
.47∗∗
.47∗∗ .34∗
.33# .41∗ .40∗
GN Psychological Composite Butchphobia Femiphobia distress .76∗∗∗ .75∗∗∗ .73∗∗∗ .68∗∗∗
Overall GN composite
−.14 −.38∗ .01 −.01
.07 −.17 .09 −.12
.05 .18 −.22 −.14
− .18
− .04
− .03
Attitudes toward GN Butchphobia Femiphobia
.53∗∗∗
.04 .23
Note. Most correlations were based on data from all female participants (N = 44). Correlations involving observer-rated GN (except for its correlation with the overall GN composite) were based on data from female participants who agreed to be videotaped (N = 32). ∗∗∗
p < .001; ∗∗ p < .01; ∗ p < .05; # p < .10.
Gender nonconformity Tables 1 and 2 show correlations among out major variables of interest for lesbians and gay men, respectively. As predicted, many of the measures of self-reported gender nonconformity were related for both groups. For lesbians, all of the self-report measures of gender nonconformity were significantly positively correlated. For gay men, however, only the correlation of adult continuous gender identity and childhood gender nonconformity was statistically significant. The four dimensions of observer-rated gender nonconformity (voice, movement, appearance, and overall impression) were all highly positively correlated for both lesbians and gay men (all ps < .01). As a result, we created an observerrated gender nonconformity composite variable by standardizing and adding the four dimensions of observer ratings for lesbians and gay men separately. This observer-rated gen-
Table 2 gay men
der nonconformity composite was used in the remaining analyses. Observer and participant ratings of gender nonconformity showed moderate to high agreement. For lesbians, the observer-rated composite was significantly and positively related to all measures of self-reported gender nonconformity. For gay men, the observer-rated composite was significantly and positively related to childhood gender nonconformity, and correlations with the other self-report measures of gender nonconformity were in the expected direction. Thus, we created an overall gender nonconformity composite variable by standardizing and adding scores on the four measures of gender nonconformity for lesbians and gay men separately: childhood gender nonconformity, adult continuous gender identity, occupational and hobby interests, and the observerrated gender nonconformity composite. We assigned the mean observer-rating score for the relevant group (lesbians
Correlations among measures of gender nonconformity (GN), attitudes toward gender nonconformity, and psychological distress for Childhood Adult ObserverGN CGI Interests rated GN
Self-rated GN Childhood GN Adult continuous gender identity (CGI) Interests Observer-rated GN Overall GN composite Attitudes toward GN Butchphobia Femiphobia
.56∗∗∗ .22 .23
.42∗ .24 .27
GN Psychological Composite Butchphobia Femiphobia distress .77∗∗∗ .72∗∗∗ .62∗∗∗ .66∗∗∗
−.02 −.11 −.10 .03
−.06 −.19 −.32∗ −.07
.38∗∗ .46∗∗∗ .23 .07
− .07
− .23
.41∗∗
.54∗∗∗
.03 −.11
Note. Most correlations were based on data from all male participants (N = 50). Correlations involving observer-rated GN (except for its correlation with the overall GN composite) were based on data from male participants who agreed to be videotaped (N = 35). ∗∗∗
p < .001; ∗∗ p < .01; ∗ p < .05.
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Gay men reported significantly higher levels of psychological distress than lesbians on measures of both depression, t(92) = 2.14, p = .035, and trait anxiety, t(92) = 2.44, p = .017, but not state anxiety. For both lesbians and gay men, total scores on the measures of psychological distress were all highly positively correlated. We focused on scores on the BDI and the trait scale in these analyses because we reasoned that depression and trait anxiety better corresponded to the latent variable of interest, psychological distress, than did anxiety “at this moment,” which was measured by the State subscale. We thus created a psychological distress composite variable by standardizing and adding the depression and trait anxiety scores for lesbians and gay men separately; this composite was used in the remaining analyses. Consistent with our hypothesis, psychological distress was positively correlated with the overall gender nonconformity composite for gay men (see Table 2). Psychological distress was not significantly related to gender nonconformity for lesbians (see Table 1). These results did not change when controlling for age. The correlation between gender nonconformity and psychological distress in gay men was significantly different from that in lesbians, z = − 2.18, p = .029 (two-tailed). Of note, when examining individual measures of gender nonconformity, there were significant positive correlations between psychological distress and various selfreport indices of gender nonconformity for gay men, but not for lesbians. However, observer ratings of gender nonconformity were not significantly related to psychological distress for either lesbians or gay men. It seemed possible that the pattern found for gay men might be due in part to socioeconomic status. Prior research has found greater psychological distress in individuals lower in socioeconomic status (Lorant et al., 2003; Mulatu & Schooler, 2002). If gay men who are more gender nonconforming also tend to be lower in socioeconomic status, this could partly explain our findings. To examine this possibility, we used education level as an indicator of socioeconomic status. Although educational level was, in fact, negatively correlated with gender nonconformity for gay men, r = − .28, p = .046, gender nonconformity still significantly predicted distress in gay men when controlling for educational level, β = .13, p = .0059, R2 < .001. We also considered the possibility that a response bias might influence participant responses. One way to address this with these data was to test for the possibility that gender nonconforming individuals who were more distressed might have a negatively distorted view of their own nega-
Attitudes toward gender nonconformity Figure 1 shows the mean ratings for lesbians and gay men separately on the four feeling thermometer items. A 2
Feeling Thermometer Ratings by Lesbians 100 90
Mean Likeability Rating
Gender nonconformity and psychological distress
tive traits compared to nondistressed gender nonconforming individuals. Because both heterosexual and homosexual people in general have negative attitudes towards gender nonconformity, it might be considered a negative trait. If true, then individuals experiencing high levels of distress might show self-reported gender nonconformity that exceeds their observer-rated gender nonconformity. In contrast, lowdistress individuals might have self-reports of gender nonconformity that are more consistent with observer ratings. To address this possibility, we tested for an interaction between psychological distress and observer ratings of gender nonconformity in predicting self-reports of gender nonconformity. This interaction was not significant for lesbians, β = .052, R2 = .24, or for gay men, β = − .10, R2 = .40.
80 70 60 50 40 30
Target's Conformity
20
Conforming
10
Nonconforming
0
Female
Male
Target's Gender
Feeling Thermometer Ratings by Gay Men 100 90
Mean Likeability Rating
or gay men) to participants for whom observer ratings were missing. This overall gender nonconformity composite was used in subsequent analyses.
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80 70 60 50 40 30
Target's Conformity
20
Conforming
10
Nonconforming
0
Female
Male
Target's Gender
Fig. 1 Lesbians’ and gay men’s liking of gender conforming and gender nonconforming women and men (0 = not at all; 100 = extremely)
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(sex of participant) × 2 (sex of target) × 2 (gender behavior: conforming vs. nonconforming) mixed design analysis of variance revealed that ratings of gender conforming individuals were more positive than ratings of gender nonconforming individuals, F(1, 92) = 56.19, p < .001. Interpretation of this main effect was qualified by a three-way interaction among rater sex, target sex, and target gender nonconformity, F(1, 92) = 8.92, p = .004. Specifically, lesbians liked gender conforming women more than gender nonconforming women, t(43) = 3.84, p < .001, but did not have a preference in men, t(43) = − .25. In contrast, gay men preferred gender conformity over gender nonconformity in both women, t(49) = 6.35, p < .0001, and men, t(49) = 7.08, p < .0001. Thus, both lesbians and gay men reported greater liking for gender conforming than for gender nonconforming members of their own sex. In addition, gay men also reported a preference for gender conformity over gender nonconformity in women. For both lesbians and gay men, responses on the butchphobia subscale were negatively correlated with the “masculine women” feeling thermometer question, and responses on the femiphobia subscale were negatively correlated with the “feminine men” question. For ease of interpretation, we first reverse-scored these two subscales so that higher scores reflected more positive attitudes towards masculine women and feminine men, respectively. Next, both subscales and both feeling thermometer questions were standardized and added for lesbians and gay men separately to form composite scores of butchphobia and femiphobia, which were used in the remaining analyses. Butchphobia and femiphobia scores were positively correlated for both lesbians and gay men (see Tables 1 and 2), suggesting that attitudes towards gender nonconformity in females tend to be related to attitudes towards gender nonconformity in males. Attitudes towards gender nonconformity were not significantly related to the overall gender nonconformity composite for either lesbians or gay men. Interestingly, however, among both lesbians and gay men, the correlation between the overall GN composite and attitude toward gender nonconformity in one’s own sex was negative. This suggests that more gender nonconforming participants may have less positive attitudes toward gender nonconformity in those of their own sex. Finally, there were no significant relationships between participants’ attitudes and their degree of psychological distress.
Discussion Consistent with our hypothesis and prior research, selfreported gender nonconformity was related to psychological distress in gay men. Gay men who reported more childhood Springer
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and adult gender nonconformity also tended to report more psychological distress. However, we did not find a similar relationship between psychological distress and observerrated gender nonconformity, nor was psychological distress significantly related to any of the measures of gender nonconformity for lesbians. Gender nonconformity and psychological distress in gay men Several mechanisms could be responsible for the link found in gay men between gender nonconformity and psychological distress. Because homosexual individuals continue to face widespread victimization, and because feminine men are often perceived to be homosexual (Deaux & Lewis, 1984; Haddock et al., 1993; Herek, 1991; Martin, 1990), gender nonconforming gay men may experience more stigmatization than more gender-typical gay men, and this may result in more psychological distress (D’Augelli, Pilkington, & Hershberger, 2002; Herek et al., 1999). A related pathway involves the importance of social support to stigmatized minority populations. More gender nonconforming gay men may receive less social support from others because of other people’s negative attitudes towards gender nonconformity, and this lack of social support may make them more susceptible to psychological distress (D’Augelli & Hershberger, 1993; Elizur & Ziv, 2003). Moreover, the negative attitudes toward gender nonconformity found among gay men in our study and in other research suggest that gender nonconforming gay men may face rejection from others even within their own minority group, both romantically (Bailey et al., 1997) and socially. In-group minority social support may protect minority group members to some extent from the negative effects of stigma (e.g., Friedman & Downey, 1999; Grossman & Kerner, 1998; Meyer, 2003). A potential lack of such support thus may play a role in the relationship between gender nonconformity and psychological distress in gay men. Socioeconomic status might also partially explain these results. More gender nonconforming men might tend to have lower socioeconomic status on average, and lower socioeconomic status is associated with greater psychological distress (e.g., Lorant et al., 2003, Mulatu & Schooler, 2002). We were partially able to rule out this explanation; although the more educated men in our sample did tend to report less gender nonconformity on average, the relationship between gender nonconformity and distress remained significant after controlling for education. However, future studies including more detailed demographic information should further address this issue. A response bias also could have influenced our results. That is, those gay men who reported more psychological distress may be more open about reporting negative traits in
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general (Larsen & Diener, 1987), including gender nonconformity, which is viewed negatively by many homosexual individuals, as we found in this sample. Gender nonconforming men who are more distressed might also have a distorted view of their own gender nonconformity and see themselves as even more gender nonconforming than they actually are. However, we found no significant interaction between observer ratings of gender nonconformity and participants’ psychological distress in predicting self-reported gender nonconformity. The evidence suggests that gay men who are experiencing high levels of psychological distress are not distorting reports of their own gender nonconformity compared to gay men who are experiencing low levels of distress. One final possibility is that the characteristics related to femininity that we measured may be associated with an underlying risk for mood and anxiety problems. In our sample, gay men had more symptoms of depression and anxiety on average than lesbians, an interesting reversal of the sex difference in heterosexual women and men for mood and anxiety problems (American Psychiatric Association, 2000). Bailey (1999) hypothesized that the higher rate of distress among gay men compared with heterosexual men may result from a higher, more female-typical, level of neuroticism in the former. However, one study found that the association between perceived discrimination and distress weakened but remained significant after controlling for neuroticism (Huebner et al., 2005). This explanation bears further exploration.
Self-reports versus observer ratings of gender nonconformity Contrary to our expectations, observer ratings of gender nonconformity were not significantly related to psychological distress in our sample. This seems inconsistent with the idea that psychological distress may be partly due to stigmatization of gender nonconformity, and/or a decrease in social support, as discussed above (Beard & Bakeman, 2000; Friedman & Downey, 1999, 2002; Landolt et al., 2004). Thus, the possible roles of stigmatization and social support might be less important than we originally hypothesized. Another possibility is that our measure of observerrated gender nonconformity did not capture the variable of interest as effectively as we believed it would. Our measure of observable gender nonconformity was but one indicator of what is likely a multidimensional latent construct. We used “masculine” and “feminine” endpoints on a bipolar scale for our observer ratings in order to best correspond to lay terminology, implying that a person must be closer to one than the other on a given trait. Given that individuals can be masculine in some respects and feminine in others, a bipolar scale
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oversimplifies the full spectrum and complexity of behavior that individuals can display. Furthermore, a single short assessment may contain substantial measurement error compared with the average of multiple assessments at different times. There are other possible explanations for the absence of a significant relationship between observer-rated gender nonconformity and distress. Some participants may have intentionally suppressed observable cues of gender nonconformity while being videotaped in the laboratory (Ambady & Hallahan, 2002). If so, the observer ratings in our study may not be accurate reflections of the way participants are perceived outside the laboratory. It may also be that those aspects of gender nonconformity most likely to prompt negative reactions from other people were not apparent in the videos we used. For example, it could be that the childhood play behavior of gender nonconforming boys is more likely to provoke consistently negative reactions from others compared to gender nonconformity in adult voice and movement. If this is the case, then the traits that our observers assessed may not be the ones that are most stigmatized, and thus would be expected to correlate more weakly with psychological distress. Finally, the correlation between distress and observerrated gender nonconformity was in the predicted direction and was not significantly lower than the correlation between distress and self-reported gender nonconformity. We may have had too few participants in the final sample of 35 men who agreed to be videotaped to detect a relationship. Clarification of the relationship, if any, between observable aspects of gender nonconformity and psychological distress in gay men thus deserves further study using different methods for assessing observer-rated gender nonconformity. Assuming that the lower correlations between observerrated gender nonconformity and distress than between selfreported gender nonconformity and distress are meaningful, there are several possible explanations. Perhaps the relationship between gender nonconformity and psychological distress is more attributable to personality factors or moodbiased memory and perception as discussed above; the significant relationship between distress and self-perceived gender nonconformity is certainly consistent with this hypothesis. It is also possible that psychological distress is more related to individuals’ subjective perceptions of their own gender nonconformity than to the ways that other people treat them. Consistent with this, Savin-Williams (1994) found that individuals’ perceptions of their own traits may be related to psychological distress. In his sample of gay and bisexual young males, suicide attempters were significantly more likely than non-attempters to describe themselves as feminine. Thus, the ways in which individuals identify and think about their own gender nonconformity, rather than gender nonconformity in and of itself, could be related to risk for psychological distress. Springer
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Sex differences in the relation between psychological distress and gender nonconformity Lesbians reported significantly less psychological distress than did gay men. In addition, the correlation between selfreported gender nonconformity and psychological distress among gay men in our study was not found for lesbian participants. Several factors could account for these differences. One might be greater acceptance of gender nonconformity in women than in men. Given a possibly more favorable view of gender nonconforming women than men, it is striking that our lesbian and gay participants on average reported greater liking for feminine women than for masculine women. They may be evaluating gender nonconformity in women less positively because masculine characteristics in women may be associated with a decrease in perceived attractiveness (Bailey et al., 1997). However, despite some evidence of negative attitudes towards gender nonconformity in women as well as men, perhaps gender nonconforming women still experience less negative treatment than do gender nonconforming men. This would be consistent with findings that lesbians experience less verbal harassment and threats than do gay men (e.g., Berrill, 1992). However, other studies have found greater lifetime victimization in lesbians compared to gay men (Balsam et al., 2005). Therefore, this explanation alone may not be sufficient to explain these differences; alternatively, certain types of victimization may relate more strongly to distress than others. A sex difference in the social consequences of adult gender nonconformity might partially explain the sex differences in psychological distress and its correlation with gender nonconformity. Interpersonal factors in childhood may also contribute to these sex differences. For example, greater societal acceptance of gender nonconformity in girls than in boys leads to differences in how gender nonconforming girls are treated compared to gender nonconforming boys (Maccoby, 1998; Martin, 1990). Although young children’s attitudes towards gender nonconformity may be complex (Zucker et al., 1995), young boys generally appear to reject gender nonconforming boys (Fagot, 1995; Friedman & Downey, 1999), who then may only be partially accepted into girls’ groups (Maccoby, 1998). Gender nonconforming boys might then be deprived of the benefits of affirmative relationships with girls for various reasons, such as girls’ attitudes towards boys generally, or the reactions of girls’ parents to gender nonconformity specifically. Rejection experienced by feminine boys may lead to distress about both their gender and their atypical behavior. As noted above, gender nonconforming girls may not be rejected as much or even at all compared to gender nonconforming boys (Friedman & Downey, 1999; Maccoby, 1998); this might explain the sex difference in the relationship between gender nonconformity and distress. Interpersonal factors Springer
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such as stigmatization and social support may mediate or moderate this relationship. Further research on such factors might clarify the reasons for these sex differences. Limitations Although some of our hypotheses were supported, our study had several limitations. Potential problems with our observer ratings of gender nonconformity have already been discussed. Another limitation is that our Attitudes Towards Gender Nonconformity Scale, although specifically developed to measure butchphobia and femiphobia, has yet to be fully validated. Preliminary exploratory factor analyses of this instrument have yielded a two-factor solution with the expected items loading on factors that correspond to butchphobia and femiphobia. However, further validation of this instrument will be necessary before firm conclusions can be drawn about results based on this measure. The cross-sectional design of our study is another limitation, and we did not assess psychological distress through approaches less susceptible to self-report biases, such as clinical diagnoses or measures of daily functioning such as occupational status. Our use of a volunteer sample from a city with a large, visible lesbian and gay population could also limit generalizability of these findings. Future directions This study provided an investigation into the relationship between gender nonconformity and psychological distress, but many questions remain. Longitudinal studies following large groups of children showing a range of gender conforming and nonconforming behaviors into adulthood could provide a more thorough examination of the relationship between gender nonconformity and psychological health. Multiple measurements of psychological distress at several time points would further strengthen such a study. Corroborative information, such as observations by the parents or peers of participants, would also be useful additions to such research. Studies exploring the role of stigmatization experiences of lesbian and gay individuals more directly are also important. These might include experimental manipulations of stigmatization using confederates in laboratory settings. Studies incorporating measures of social support will also assist in better understanding how social factors impact the relationship between gender nonconformity and psychological distress in gay men specifically and psychological health among lesbians and gay men in general. Some gay men may develop a dislike of their own degree of femininity, much as some lesbians and gay men can develop a strong dislike of their own sexual orientation, or internalized homophobia. One might predict that this might be both stronger and more likely to occur for more gender
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nonconforming gay men compared to more gender conforming gay men. Such “internalized femiphobia” may plausibly play a role in the relationship between gender nonconformity and psychological distress. However, this variable has yet to be systematically documented and may merit future study. Delineating the factors that contribute to or reduce psychological distress in lesbians and gay men remains a significant minority mental health issue for psychologists, healthcare professionals, and public policy makers (Meyer, 2003). Continued exploration of factors involved in the relationship between gender nonconformity and psychological distress, including stigmatization and social support, may lead to improvements in psychological interventions designed to support lesbians and gay men. Efforts aimed at reducing stigmatization of gender nonconformity in all individuals, regardless of their sexual orientation, may reduce the victimization faced by homosexual individuals and, as a consequence, may enhance their psychological health. Acknowledgements The authors wish to thank the following individuals: C. Emily Durbin, Galen Bodenhausen, Steve C. Garcia, Barbara Kraynek, Marina Lokshin, Richa Sachdeva, Jessica Rabinow, Gerulf Rieger, and Frederica Conrey. We also wish to thank the Editor and anonymous reviewers for their feedback on a previous version of this report.
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