Review Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2024; 16(4):731-739

doi: 10.18863/pgy.1417609

Discrimination and Violence against

Transgender People
Trans Cinsiyetlilere Yönelik Ayrımcılık ve Şiddet

Pelin Göksel1
1
Fatsa State Hospital, Ordu

Violence against transgender individuals is pervasive across many sectors, yet discourse on the issue remains
limited to a few platforms, with minimal action taken to address it. This inaction contributes significantly to public
health problems. Transgender individuals often face myriad forms of violence, including familial ostracization,
ABSTRACT

physical abuse, emotional neglect, school bullying, unemployment, and discrimination in public arenas. Such
experiences hinder their social integration and infringe on their personal rights. Research indicates that violence
against transgender people has detrimental effects on their mental health, and the rates of reporting such
incidents are distressingly low. Factors like stigma, misunderstandings by authorities, fear of transphobic
reactions, unequal legal protections, and the risk of unjust arrest discourage seeking help. These challenges
increase the vulnerability of transgender people to violence. This review will analyze the existing literature on
violence against transgender individuals and explore the societal underpinnings of such violent behaviors.
Keywords: Transgender, discrimination, violence

Trans cinsiyetlilere yönelik şiddet ile pek çok alanda karşılaşılmakta ancak sınırlı platformlarda konuşulmakta ve
önlemek amacıyla neredeyse hiçbir şey yapılmamaktadır. Bu tepkisizlik halk sağlığı açısından önemli sorunlara yol
açmaktadır. Aileden uzaklaşmaya zorlanmak, fiziksel şiddet, duygusal ihmal, okulda zorbalık maruziyeti, işsiz
bırakılmak, kamusal alanda uygulanan ayrımcılık bu şiddet olaylarının birkaçıdır ve bu durum trans cinsiyetlilerin
toplumsal hayata entegre olmalarını ve kişisel haklarından yararlanmalarını engellemektedir. Yapılan çalışmalar
transların deneyimledikleri şiddet olaylarının olumsuz ruh sağlığı sonuçlarına yol açtığını, bu vakaların bildirilme
ÖZ

oranlarının çok düşük olduğunu, yardım arama davranışlarının damgalanma, yetkililerce anlaşılmama, transfobik
tutumlarla karşılaşma korkusu, eşit olmayan yasal düzenlemeler, nedensizce tutuklanma korkusu gibi nedenlerle
engellendiğini, tüm bu engellerin transları şiddete daha savunmasız hale getirdiğini göstermektedir. Bu gözden
geçirmede trans cinsiyetlilere yönelik şiddet olaylarıyla ilgili literatür incelenecek, şiddet davranışlarının toplumsal
temelleri tartışılacaktır.
Anahtar sözcükler: Trans cinsiyet, ayrımcılık, şiddet

Introduction
Transgender, often abbreviated as trans, is an inclusive term referring to individuals whose gender identity or
expression typically does not align with the sex assigned at birth expectations (Shaw et al. 2012). Cisgender, on
the other hand, denotes individuals whose gender identity aligns with the sex assigned at birth (Polat and Şirin
2020). Gender identity refers to how a person perceives themselves in a gender category (Stoller 1964). Sexual
orientation, on the other hand, pertains to a person's sexual and emotional attraction towards a gender and is
independent of gender identity. If this orientation aligns with one's own gender, it is termed homosexual; if it
aligns with the opposite gender, it is termed heterosexual; and if it aligns with both genders, it is termed bisexual
(Polat and Şirin 2020).
Studies focusing on the experiences of transgender people (Goodrich 2012, Uluyol 2016, Aypar and Tanyaş
2017) report various psychological challenges such as distress stemming from incongruence between gender
identity and biological sex, concerns regarding the social consequences of gender identity, fear of non-
acceptance, internalized transphobia, and anxiety about the future. Transgenders also report experiencing
different types of violence in various settings such as public spaces, within families, and in school environments.
Similar to other sexual minority people, transgenders encounter negative attitudes and behaviors due to their
gender expressions not conforming to societal normative values, and the nature and severity of this violence
and discrimination vary based on the societal understanding and acceptance levels (Stotzer 2009, Rogers 2017).

Address for Correspondence: Pelin Göksel, Fatsa State Hospital, Ordu, Türkiye
E-mail: [email protected]
Received: 10.01.2024 | Accepted: 03.04.2024
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 732

In a survey conducted in the United States (Casey et al. 2019), the experiences of Lesbian, Gay, Bisexual,
Transgender, and Queer (LGBTQ) people were examined. According to the findings of this study, 84% of
transgenders believed that discrimination against transgender people exists in America, 38% reported the use
of derogatory language towards transgenders, and 28% directly experienced negative and disturbing remarks.
Furthermore, 10% of transgender participants reported experiencing discrimination while accessing healthcare,
22% avoided seeking healthcare due to fear of discrimination, and 27% considered moving to another state due
to being marginalized. Despite the significant negative experiences reported (Greenberg 2012), the rates of
reporting these experiences are very low, and certain legal or cultural norms contribute to keeping these
experiences hidden.
A comprehensive study on the subject was conducted in Vietnam (Yen et al. 2016), revealing that discrimination
and violence against transgender students are often perpetrated by other students, but administrators and
educators are also responsible for this situation. Transgender students often lack access to adequate support to
cope with these issues, and stigmatization and discrimination are widespread at the institutional level.
According to the findings of this study, transgender women and gay male students experienced higher rates of
violence compared to transgender men and lesbian students. Based on this finding, it was interpreted that there
is a higher motivation in society to punish feminine expressions in male bodies. The results of a study offering
an educational plan to prevent violence against sexual minorities in schools (Barragan-Medero and Perez-Jorge
2020) emphasized the importance of students being knowledgeable about sexual differences and developing
skills to recognize and manage conflicts in their surroundings. The study also underscored the need for state
policies to support the struggle against exclusionary binary gender concepts.
Developed by Ilan Meyer (2003), the "Minority Stress Theory" provides a framework to understand and explain
why the prevalence of psychiatric disorders is higher among Lesbian, Gay, and Bisexual (LGB) people compared
to heterosexuals. In this framework, negative experiences due to sexual differences are considered external
factors, while the anticipation and fear of experiencing negative experiences are regarded as internal factors.
Additionally, this model claims that coping mechanisms and social support resources can vary the negative
impact of minority stress on mental health. Originally conceptualized for LGB people, the theory has been
adapted to encompass all sexual minority groups and has been utilized in research (Hendricks and Testa 2012,
Goldenberg et al. 2020). Studies on violence experienced by gender minority groups (Budge et al. 2013, Yüksel
et al. 2017, Akgül and Ayaz 2021) report insufficient support resources compared to other minority groups,
resulting in adverse mental health outcomes and increased suicide risk. This review aims to address incidents of
violence against transgenders across different platforms, contribute to the limited Turkish literature on the
subject, and raise awareness.

Violence
The World Health Organization defines violence as the intentional use of physical force or power, threatened or
actual, against oneself, another person, or a group or community, resulting in injury, psychological harm, death,
developmental delay, or deprivation, or the likelihood of such occurrences (Krug et al. 2002). Violence
perpetrated by the dominant masculine gender, stemming from unequal power dynamics in the binary gender
system, is referred to as gender-based violence (Wirtz et al 2020, Tsapalas et al. 2021). While previously violence,
typically perpetrated by men against women, was understood in this context, the definition has evolved to
encompass violence experienced by individuals in minority and vulnerable positions due to their lack of power
in recent time (White and Goldberg 2006, Dolan 2015). According to a briefing note published by the United
Nations Human Rights Committee, violence against Lesbian, Gay, Bisexual, and Transgender (LGBT) people is
defined as a form of societal gender-based violence driven by a desire to punish those perceived as not
conforming to gender norms (United Nations 2022).

Some Concepts Associated with Gender-Based Violence

Heteronormativity and the binary gender system accept distinct and complementary female or male gender
categories corresponding to biological sex and defined according to reproductive physiology (Bem 1981). Coined
by Michael Warner (1991), this term has been used to emphasize the societal understanding of sexual minorities
as a low-status group and heterosexuality as a privilege within normative society.
The heteronormative system is structured by hegemonic norms, practices, and expressions that consider
heterosexuality as natural and superior, thus legitimizing homophobia, transphobia, and all forms of
discrimination against sexual minorities (Robinson 2016) Gender-based violence is rooted in entrenched
733 Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry

assumptions about what it means to be a man or woman in a society. In the globally dominant heteronormative
order, those who deviate from accepted boundaries become targets of violence (Fried and Teixeria 2014).
Transphobia can be defined as an irrational response to those who deviate from the patterns of sociocultural
gender teachings (Whittle and Turner 2009). Some researchers (Bettcher 2007, Perry and Dyck 2013) have
argued that these reactions emerge when the masculine gender status is perceived as threatened, and those who
do not conform to binary gender acceptance are seen as dangerous in terms of societal gender norms, inciting
anger and hatred towards transgender people. Additionally, it is believed that social sexism reinforces negative
evaluations of non-cisgender identities as abnormal, triggering individual-level behaviors of disgust and gender-
based derogation (Hill and Willoughby 2005).

Incidents of Violence Experienced by Transgenders

There are a limited number of studies examining incidents of violence against transgenders. The most
comprehensive research on the subject, the United States Transgender Survey (James et al. 2016) with 27,715
participants has addressed transgenders' experiences of violence across various platforms. According to this
survey, 54% of transgender respondents reported experiencing intimate partner violence, 46% reported verbal
harassment, 10% reported sexual assault, 9% reported physical assault, and 14% reported not receiving equal
treatment in public spaces or being denied access to social services.
Studies on gender minority groups' experiences of violence indicate that transgender adolescents experience
significantly higher levels of violence from childhood compared to their cisgender peers. However, experiences
of discrimination, bullying, and stigmatization vary depending on factors such as early awareness of gender
identity, belonging to any minority group, and the sociocultural characteristics of the environment (Verschoor
and Poortinga 1988, Reisner et al. 2014)
In recent years, increasing studies on gender-based violence (Witcomb et al. 2019, Austin et al. 2022, Silva et al.
2022, Chan et al. 2023) have shown that transgenders experience high levels of domestic violence and emotional
neglect, face inequalities and biases in public spaces, have their personal rights hindered, are vulnerable to
bullying in schools, particularly in the form of name-calling and mockery based on appearance, and have high
rates of childhood sexual experiences and intimate partner violence in all forms. All these negative experiences
are associated with poor physical and mental health outcomes, low academic achievement, increased suicide
rates, barriers to accessing healthcare services, increased rates of sexually transmitted diseases, and escalating
stigma and social isolation (Wirtz et al. 2020, Sánchez-Fuentes et al. 2021, Akande et al. 2023, Bourne et al.
2023, Xu et al. 2023).

Studies on Domestic Violence

Any abuse, violence, or threat directed at an individual within the family, regardless of gender, is defined as
domestic violence. While research on this topic largely focuses on intimate partner violence, this definition
applies to all forms of violence perpetrated by adult family members (Home Office 2012). However, when
examining exposure to domestic violence in the context of gender dysphoria, research often tends to focus on
intimate partner violence. In this context, the term "domestic violence" is used to refer to violence experienced
from one's primary family, and studies addressing this issue are relatively limited compared to research on other
forms of violence experienced in gender dysphoria (such as bullying, intimate partner violence).
Some researchers (Link and Phelan 2001, Butler 2004) have argued that families' refusal to have a transgender
child is associated with fear of stigma and loss of social status. In many cultures, it is believed that the social
status of the family is prioritized over the well-being of the transgender child, and maintaining a reputable family
image is associated with factors such as positive self-perception, economic opportunities, and reputation
(Brandon et al. 2008). Some of the studies (Goffman 2009) focusing on the domestic violence exposure of trans
people suggest that these behaviors have a strong relationship with the concepts of stigma and honor.
In a large-scale study (Bourne et al. 2023) conducted with LGBTQ participants in Australia, it was found that
when directly asked, 30.93% of participants reported experiencing domestic violence, whereas when asked in a
more nuanced and detailed manner, this percentage increased to 43.18%. The study also demonstrated that this
exposure varied with demographic characteristics such as age, gender, and marital status. This research suggests
that gender minority people struggle to label their negative experiences within the family as violent or abusive,
making it difficult for them to seek legal recourse. The results of this study are consistent with Barnes' (2008)
view that the difficulty in naming violence reinforces the feeling of isolation and constitutes an obstacle to
seeking help.
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 734

A study (Kenagy and Bostwick 2005) conducted in Chicago included 111 transgender participants, with 66% of
participants reporting experiencing violence in their homes. However, no distinction was made based on genders
or types of violence. In another stud the rate of domestic violence among transgenders was found to be 56.3%,
with the conclusion that transgender women were more likely to be victims of violence (Kenagy 2005). In a
comprehensive survey (Peng et al. 2019) conducted in China, 92.8% of transgender and non-binary participants
reported experiencing parental neglect or abuse, with economic control being identified as the most prevalent
form of violence (66.1%). According to the results of the United States Transgender Survey (James et al. 2016),
53% of transgenders experienced psychological violence from their families due to their gender identity, and
65% attempted suicide due to their experiences of domestic violence within their families.
In a recent study conducted in Turkey (Tüzün et al. 2022), the levels of depression and anxiety among
transgender youth during the Covid pandemic were examined. This study found that participants who
experienced difficulty expressing their gender identity and did not receive sufficient support from their families
had higher levels of depression and anxiety. Another study (Şahin and Gençer 2023) involving sexual minority
groups showed that parental acceptance was associated with lower levels of depression and anxiety.
Nevertheless, especially transgender women often find themselves compelled to continue living in households
where they experience violence, frequently failing to report incidents of domestic violence. Economic
dependence, limited housing options, social isolation, and service providers' transphobic attitudes pose barriers
to seeking help. It is believed that legal regulations are the most important need and effective way to address
this concerning situation (Greenberg 2012).

Studies on Bullying at School

Bullying is defined as intentional harm inflicted by one or more youth or a group of youth, characterized by
perceived or actual power imbalance and the potential for repetition (Earnshaw et al. 2016). A study (Strauss et
al. 2020) conducted in Australia involving 859 participants between the ages of 14-25 with sexual differences
reported that 74% of the participants were exposed to bullying and 68.9% to discrimination, and these rates
were found to be higher compared to the cisgender population. A population-based study (Eisenberg et al. 2019)
focusing on the bullying experiences and emotional distress levels of adolescents with sexual orientation and
gender identity differences included 79.989 adolescents. Emotional distress and bullying victimization were
significantly higher in heterosexual transgender and gender diverse adolescents compared to their LGBT peers.
This result was interpreted as possibly explained by interventions facilitating social acceptance of transgender
youth with their desired gender (hormone therapy, psychological support etc.). However, both transgender and
LGBT adolescents experienced higher levels of bullying victimization compared to their heterosexual cisgender
peers. Additionally, emotional distress and bullying victimization scores were higher in the group identifying as
both transgender and LGBT compared to those identifying as only transgender or only LGBT. A large-scale study
(Gower et al. 2023) conducted in the United States with gender minority youth found that bullying victimization
increased for youth who identified as transgender if they held marginalized social positions. While school
bullying targeting gender minority groups may have only been addressed in the past decade, the vulnerability of
intersecting identities to bullying has been confirmed since the early studies (Poteat et al. 2011, Garnett et al.
2014, Eisenberg et al. 2019).
In a qualitative study (Earnshaw et al. 2020) examining the bullying experiences of LGBT students and the
attitudes of school health professionals (nurses, guidance counselors, psychologists), students were found to
frequently encounter behaviors such as teasing, being called derogatory names and physical violence.
Additionally, students expressed that the frequency of negative behaviors they faced increased if they had any
physical or racial differences. While school health professionals stated that they try to prevent these behaviors,
students perceive them as lacking sufficient knowledge and skills in this regard and not being supportive enough.
In summary, gender diversity contribute to bullying behaviors and the approaches of school administrators
appear to be lacking in professionalism and impartiality.
In a recent qualitative study (Henderson et al. 2022) involving gender minority youth, participants reported
experiencing various forms of negativity ranging from exclusion, physical violence, verbal abuse, being treated
as deviant, to police violence, which varied from covert attitudes to overt behaviors. The study (Hall 2017)
suggests a need for school-based awareness interventions. A systematic review focusing on interventions for
bullying in schools found that schools with specific policies experienced less bullying towards sexual minority
groups. This study emphasized the necessity of reporting bullying incidents and highlighted policies such as
735 Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry

awareness-based education. Additionally, it underscored that anti-bullying policies initiated in schools could
serve as examples for organizational arrangements.

Studies on Intimate Partner Violence

Intimate partner violence is defined as physical assault, sexual violence, stalking, or psychological aggression
perpetrated by a current or former partner (Breiding et al. 2015). A recent meta-analysis (Peitzmeier et al. 2020)
focusing on intimate partner violence in the transgender population found that transgenders had a lifetime
prevalence rate of 37.5% for physical intimate partner violence and 25% for sexual intimate partner violence,
with transgender and gender diverse individuals being 1.7 times more likely to experience any intimate partner
violence compared to cisgenders. In a study by Goldenberg et al. (2018), the lifetime prevalence of intimate
partner violence among transgender participants was found to be 45%, with higher prevalence rates observed
among those assigned gender is male at birth compared to those assigned gender is female at birth. This study
also identified associations between intimate partner violence exposure and negative mental health outcomes.
While transgender people have higher rates of intimate partner violence exposure compared to the cisgender
population, there are also differences in the forms of violence they experience (Yerke and DeFeo 2016). Studies
(Brown 2011) have shown that transgenders are subjected to violence by their partners through threats of
disclosing their transgender identity to family members or employers, exploiting vulnerabilities related to their
sexual differences. Perpetrators may also prevent access to health services necessary for gender affirmation as a
form of violence. Additionally, researchers (White and Goldberg 2006, Ristock 2011) suggest that perpetrators
specifically target transgenders' sexual organs and unwanted bodily features, viewing them as "more vulnerable"
in intimate partner violence situations.
Intimate partner violence and Human Immundeficiency Virus (HIV) are interrelated problems that reflect the
consequences of gender-based power inequalities (Kouyoumdjian et al. 2013). While there is a comprehensive
literature on the relationship between intimate partner violence and HIV among cisgender women, there are
very few studies (Mittal et al. 2017, Peitzmeier et al. 2020) examining this relationship among transgender
women, despite the significantly higher prevalence of intimate partner violence exposure among them.
Transgender women are among the most affected populations by HIV. Estimates based on studies suggest that
in the United States, 14-16% of transgender women are HIV positive, while globally, this rate is around 19%.
Compared to cisgender adults, transgender women are 32.4 times more likely to be infected with HIV (Baral et
al. 2013, Becasen et al. 2020). However, there are very few programs aimed at preventing intimate partner
violence and HIV prevalence among transgender women, highlighting the urgent need for interventions in this
area (Brennan et al. 2012, Nuttbrock et al. 2013).

Studies on Violence and Discrimination in the Public Sphere

According to the results of the United Stated Transgender Survey (James et al. 2016), 58% of trans people have
experienced at least one incident of violence such as inappropriate gender expression, sexual violence, and
physical violence by the police in the last year. In this study, more than half of the participants stated that they
avoided seeking help from the police due to fear of negative treatment. Transgenders encounter various forms
of violence when seeking services from court personnel, emergency management, emergency department staff,
and personnel assigned to protect against domestic violence (Grant et al. 2011) In a recent study (Göçmen and
Yılmaz 2017) conducted in Turkey, perceived direct and indirect discrimination in accessing services such as
health care, employment, and education among LGBT people was investigated. The study found that 53% of
participants did not disclose their sexual orientation to health care providers, 23.8% experienced negative
attitudes towards LGBT people in the workplace, 14% were subjected to mistreatment by health care providers,
and 21.8% frequently experienced and 12% always experienced negative behaviors in school due to their sexual
orientation.
An important result of the studies (Kattari et al. 2020) is that such behaviors encountered by the gender minority
group in the public sphere constitute an obstacle to receiving health services. A recent study (Kattari et al. 2021)
on the subject concluded that 33% of transgender people had at least one negative experience when they applied
for health care, and that low-income and disabled participants were more often mistreated in health institutions.
In a study (Soner and Aydın Avcı 2023) conducted in Turkey investigating the expectations of LGBT people in
the health environment, it was emphasized that expectations such as legal regulations, informing health
practitioners, positive communication and attitude come to the fore and laws against discrimination in the field
of health are necessary.
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 736

Unemployment rates in the transgender population are higher than in society, and the employment rates of
trans women are lower than trans men (James et al. 2016). In addition, as perceived gender mismatch increases,
unemployment rates increase and there is more discrimination (Miller and Grollman 2015, Leppel 2016).
Difficulties in accessing employment services lead to being pushed into sex work, which increases the rates of
exposure to sexual violence and the risk of sexually transmitted infections (Cingöz Ulu and Sayılan 2016, Logie
et al. 2017). However, although the risk of sexually transmitted diseases is high, transgender people have
problems applying to health services due to lack of information, problems with social security and fear of
discrimination (Onur Şimşek and Özgülnar 2024).
In a qualitative study (Sánchez-Fuentes et al. 2021) on transphobia and gender identity, thesocial
representations of transgender women in Brazil and Colombia were investigated. In this study, themes of
violence, discrimination, prejudice, denial of rights, and family support were identified. Participants expressed
that their efforts to integrate into social circles were hindered by societal anger and prejudice, highlighting
society's profound ignorance about gender diversity and how it reinforces transphobia. They also voiced the pain
they experienced due to discrimination from childhood to adulthood. The findings of this study are consistent
with previous research (Radkowsky et al. 1997, Almeida 2010), indicating difficulties in accessing social rights
at every stage, intolerant attitudes in public spaces, low self-esteem due to social isolation, depression, and
increasing feelings of loneliness resulting in losses in education, employment, cultural activities, and social
security areas. Additionally, this study aligns with previous research (Lacerda et al. 2002, Rogers 2017) in
showing that transphobia originates from entrenched social norms and is influenced more by cultural factors
than concepts associated with religion.
Despite the alarming levels of discrimination, abuse, and social and economic marginalization, there is a glaring
lack of official data collection efforts on transgender murders, and gaps in data tracking systems hinder access
to the true rates of transgender murder (Stotzer 2017). A study (Dinno 2017) conducted in the United States to
estimate transgender murder rates concluded that transgenders do not have a higher risk of murder compared
to cisgenders. The result of this study was explained by transgenders mastering strategies to reduce their
potential for harm by concealing their identities. However, the likely more significant reason for the low rates
of transgender murders being found is the lack of an established understanding of transgender identity, as well
as issues related to death reporting systems and census inaccuracies.

Conclusion
When reviewing the literature, it is evident that transgender people experience higher rates of violence across
various platforms compared to the cisgender population. The main cause of these violent incidents is entrenched
societal norms and expectations, namely the heteronormative social order. This situation leads to significant
issues for the transgender population, including adverse mental health outcomes, low academic achievement,
unemployment, being pushed into sex work, and a higher risk of sexually transmitted diseases. When examining
the literature on violence against transgenders, it is noticeable that the reporting of such incidents is very low,
and there are deficiencies in recording reported cases. Future studies addressing violence rates will need to
propose methods to address this issue. Additionally, it is expected that the results of research on interventions
aimed at preventing violent incidents will provide a basis for legal regulations.

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Authors Contributions: The author(s) have declared that they have made a significant scientific contribution to the study and have assisted in the
preparation or revision of the manuscript
Peer-review: Externally peer-reviewed.
Conflict of Interest: No conflict of interest was declared.
Financial Disclosure: No financial support was declared for this study.